research & training center in service coordination cfda # 84.324l
DESCRIPTION
Research & Training Center in Service Coordination CFDA # 84.324L. Service Coordination: Are We There Yet? Gloria Harbin, Ph.D. Kathleen Whitbread, Ph.D. University of Connecticut A.J. Pappanikou Center For Developmental Disabilities 263 Farmington Avenue, MC6222 Farmington, CT 06030 USA - PowerPoint PPT PresentationTRANSCRIPT
Service Coordination: Are We There Yet?
Gloria Harbin, Ph.D.Kathleen Whitbread, Ph.D.
University of Connecticut A.J. Pappanikou Center For Developmental Disabilities
263 Farmington Avenue, MC6222Farmington, CT 06030
USAPhone: (860) 679-1500
Fax: (860) [email protected]
Website: www.uconnucedd.org
Research & Training Center in Service Coordination
CFDA # 84.324L
This is a Collaborative Project
Four primary sites:
Mary Beth Bruder, Ph.D., University of Connecticut
Gloria Harbin, Ph.D., University of North Carolina-Chapel Hill
Michael Conn-Powers, Indiana University
Sara Miranda, Federation for Children with Special Needs, Massachusetts
Additional research being conducted by:
Richard Roberts, Ph.D., Utah State University
Carl Dunst, Ph.D., Orelena Hawks Puckett Institute
Principles
Collaborative model of integrated activities.
Families are an integral component of our project.
Stakeholders contribute to all phases of the center activities.
Use of a Participatory Research Model.
Center Framework
Family
Service Provision
System Administration
Status
Outcomes
Recommended Practices
Measurement
Training Model
Dissemination
Surveys Focus Groups
DelphiTechnique
OutcomeMeasurement
Validation Studies
I.
II.
III.
IV.
V.
VI.
Objective 1
HOW WE DID IT:
Described current models of service coordination
WHAT WE DID:
Series of Surveys
Survey Design
Part C Survey
Examine current models of SC Roles of Parents SC Policy Monitoring and evaluation SC Financing
49 closed-ended questions
Mail, e-mail, faxes
Curricula Survey
Status of Part C SC training-models-curricula-follow-up
5 open-ended questions
Telephone interview, emails, faxes
Parent Leader Survey
Explore families’ perceptions of their statewide system of SC.-system entry-evaluation & IFSP-service Provision-transition-training-collaboration
29 closed-ended items22 open-ended items for short responses
Parent ICC Survey
Understanding of Federal regulations to SC. Models of SC Degree ICC addressed SC Outcomes of quality SC
23 closed and open-ended questions
Telephone interviews
Survey Sampling
Part C Survey
All Part C Coordinators in 57 States and Territories
Curricula Survey
Training Personnel from 55 States and Territories
Parent Leader Survey
319 Parent Leaders in 50 States and DC
Parent ICC Survey
Parent Leaders in each of 50 States who serve on ICC boards
Survey Findings
Part C SurveyN=57
39 Part C Coordinators reported lack of uniformity in provision of service coordination
36 states used a regional approach
Service Coordinator caseloads ranged from 9-70 with a mean of 38
17 states were changing service coordination models
Curricula SurveyN=55
Average length of training in 37 states = 2-3 days
27 states mandated service coordination training
26 states were in the process of developing service coordination training
Parent Leader SurveyN=319
83 families did not learn who their service coordinator was until after the IFSP
80 noted SC is ineffective in locating advocacy services
121 parents believed service coordination was very effective in developing IFSPs that were responsive to child and family needs
Parent ICC SurveyN=50
30 ICC parent representatives considered themselves familiar with federal regulations
32 parent representatives said their ICCs were familiar with federal regulations
24 were unsure if the state had specific service coordination models
System Infrastructure:
WHAT IS NEEDED TO SUPPORT EFFECTIVE SERVICE COORDINATION
Case Study States
Dedicated and Independent
Blended with Intervention – LA
Blended with Intervention – IA
What Approaches are Used?
Dedicated - and Independent Dedicated - NOT Independent Blended with Intervention
Lead Agency (LA) Blended with Intervention
Interagency (IA) Variable(Harbin, Bruder, Reynolds, Mazzarella, Gabbard, & Staff, 2002.)
Which Model is Best?
FINDINGS:
Differences in nature of some system components
SYSTEMINFRASTRUCTURE
SERVICECOORDINATION
PRACTICESCHILD AND FAMILY
OUTCOMES
Which Model is Best?
Not a useful question
Multiple factors – not just the model were associated with positive outcomes
Approaches and their Assumptions
ANALYSIS REVEALED
Assumptions not always realized
Multiple factors could influence whether the original assumptions were realized
Dedicated Approach
ASSUMPTIONS Can spend more time on S.C. Specialist Needed Offer Broader Array More Choice for Families
Dedicated Approach
WHAT CAN GO WRONG? Case load Too large S.C. not knowledgeable about services and
resources Parents uninformed S.C. not knowledgeable about disabilities
Blended Approach
ASSUMPTIONS Most knowledgeable about child and family
needs More effectively communicate with other
providers Family more likely to reveal needs
Blended Approach
WHAT CAN GO WRONG? Knowledge of needs related to own expertise Communication doesn’t occur (no time, no
mechanism) Service provider doesn’t elicit needs
Variable Approach
ASSUMPTIONS No model is best Locals know best Individualization of approach is more
likely to meet needs
Variable Approach
WHAT CAN GO WRONG? Pragmatic decision, not data-based What locals “think is best” may not be Lack of consistency confuses parents
Influential Factors
Empowering Relationship Case Load Use of Family Support Approach
Parent Choice Array of Resources
Breadth of Service System Interagency Linkages
Influential Factors
Integration of ServicesTransdisciplinaryRoutines-Based Integrated Therapies IFSPs With All Needs and Services Interagency Training
Mechanisms to link needs to resources
Influential Factors
Learning Opportunities in Natural Settings Identification of New Needs
Frequency of ContactCase Load Interagency Linkages
Influential Factors
Knowledgeable PersonnelDiverse disabilities and conditionsResourcesCapacity building
Objective 2
WHAT WE DID:
We determined outcomes attributed to effective service coordination across
stakeholders
HOW WE DID IT:
Focus Groups, Delphi Surveys, National Surveys,
(Family and Service Coordinator Interviews and IFSP Review)
Outcome Focus Group Design
Four Focal States
Connecticut, Indiana, North Carolina, Massachusetts
Focused Conversation Workshop Method
Object LevelReflective LevelInterpretive LevelDecisional Level
“If service coordination was of the highest quality for children, families, and systems how would you know it?”
Set the ContextBrainstormCategorizeName CategoriesEvaluate the Work
Institute of Cultural Affairs
Outcome Focus Groups
Sampling Findings
47 Focus groups consisting of 397 participants in 6 stakeholder groups
ParentsService ProvidersService CoordinatorsProgram AdministratorsPhysiciansChildcare Providers
250 outcomes of high quality service coordination
Used to develop the Delphi survey instruments
Delphi Sampling
Program Admin.
Service
Provider
(Indiana)
Service
Coord.
Childcare Provider
Family Physician
86 22 144 54 80 9
Total of 395 surveys were distributed
Outcome Delphi Design
Delphi SurveysN=395 in 2 rounds
Round I1. Outcome lists for each stakeholder group coded by state and
stakeholder group.2. Outcomes across stakeholders within states sent to focus
group participants in each of 4 states.3. Participants asked to rate Outcomes on a 5 point scale: “not
at all desirable”, “a little desirable”, “somewhat desirable”, “very desirable” and “strongly desirable”.
Round I Findings Retained outcomes that >55% rated as “extremely
desirable”.
250 Outcomes reduced to 75.
Outcome Delphi Design
Round II Same stakeholders sent list of Outcomes generated by their
stakeholder group across states (e.g. all parents, all service coordinators) Same five-point scale as Round I
Round II Findings Retained outcomes that >75% rated as “extremely
desirable”
Independent raters eliminated redundant items
Yielded 10 outcomes
Reduced to 7
Delphi Outcomes
1. Children and families receive appropriate supports and services that meet their individual needs
2. Children are healthy
3. Children’s development is enhanced
4. Children have successful transitions
5. Families are involved in decision making
6. Families are informed about resources and services
7. People work together as a team
National Outcomes Survey
Parent/Practitioner SurveysParent/Practitioner Design Parent Practitioner Findings
Identified outcomes of:
-Natural Environments
-Service Coordination
-Early Intervention
Parent Practitioner Sampling
879 EI program practitioners and directors and parents of children with disabilities in 48 states
-519 Program practitioners and directors
-360 Parents
Five Outcomes were identified asprimarily desired benefits of service
coordination -System Coordination -Information and referral -Family support and resources -Family-centered practices -Teaming
Two outcomes were valuedOutcomes of all three services:
-Family satisfaction -Improved quality of life
Objective 3
WHAT WE DID:
We determined practices that lead to high quality Service Coordination
HOW WE DID IT:
Focus Groups, Delphi Surveys, National Surveys, (Family and Service Coordinator Interviews and
IFSP Review)
Practice Focus Group Design
Four Focal States
Connecticut, Indiana, North Carolina, Massachusetts
Large and Small Group Activities Introduction to Service Coordination Discussion of the tool kit available to Service Coordinators Discussion of practices that would lead to quality service coordination
Facilitation Guide“What do service coordinators have to do in order to reach the best
outcomes for children and families?”
Workshop Method
Practice Focus Groups
Sampling Findings
39 Focus groups consisting of participants in 4 stakeholder groups
Parents Service ProvidersService CoordinatorsProgram Administrators
2000+ practices that lead to outcomes of high quality service coordination
Used to develop the Delphi survey instruments
Delphi Practice Sampling
112 PTIs distributed to 12 families each
2688 surveys distributed to families
Total of 4730 surveys were distributed nationally
Part C Coordinators50 states + 3 territories
106 total surveys
Program Administrators8 per state
848 total surveys
Service Coordinators8 per state
848 total surveys
Service Providers8 per state
240 total surveys
Practice Delphi Design and Findings
Delphi I Design
1. Practice lists for each stakeholder group coded by state and stakeholder group.
2. Included practices and outcome statements from both sets of focus groups.
3. Match practices to outcomes on their stakeholder survey.
Delphi I Findings
Frequencies of practices calculated for each outcome statement.
Development of National Delphi Survey.
Practice Delphi Design and Findings
Delphi II Design
1. List of practices that support each of the outcome statements. 2. National sample of stakeholders (Part C Coordinators, Program
Administrators, Service Coordinators, Service Providers, Families) completed two practice surveys.
Delphi II Findings
Practices that lead to the outcomes.
Retained practices that >85% rated as “agreed” or “strongly agreed”.
Yielded 142 practices.
Coded into 12 themes.
Delphi Practice Themes
1. Providing information
2. Ensuring family understanding
3. Being responsive to families
4. Developing IFSPs
5. Monitoring progress
6. Ensuring family satisfaction
7. Promoting child development
8. Addressing healthcare and safety issues
9. Completing administrative responsibilities
10. Planning for transitions
11. Collaborating with community organizations
12. Engaging in professional development activities
National Practices Survey
Family SurveysFamily Survey Design:
Identified Experiences with:Early InterventionNatural EnvironmentService Coordination
Family Survey Findings:
Little or no attention is paid to non-EI services provided by EI programs
Transition planning is not reported frequently by families.
National Family Sampling:
358 parents of children with disabilities in 45 states
SCs engage in discussion of EI services but engage in considerable less action oriented practices.
Very little attention is paid to child development and learning.
Objective 4
HOW WE DID IT:
Measured outcomes and practicesof effective Service Coordination
WHAT WE DID:
Interviews with families, families’service coordinators and IFSP review
Interview Design
Four Focal States
Connecticut, Indiana, North Carolina, Massachusetts
Additional States
Arizona, Utah, Washington State
Interview Protocol
Semi-structured questions
Probes
Interview Form
Interview Sampling
Connecticut, Indiana, North Carolina, Massachusetts
IFSPsN=80
FamiliesN=80
Service CoordinatorsN=80
Ethnicity
Child’s age
Child’s level of functioning
Family location
Socio economic status
Full or Part-time employment
Caseloads
Years experience
Amount of training
Interview Sampling
Washington, Arizona, Utah
IFSPsN=30
FamiliesN=30
Service CoordinatorsN=30
EthnicityChild’s ageChild’s level of functioningFamily locationSocio economic statusESLMaternal age less than 17TANFTitle VTANF & Title V
Full or Part-time employmentCaseloadsYears experienceAmount of training
Family Demographics
Location Frequency Percent
Urban 37 37.8
Suburban 36 36.7
Rural 25 25.5
Ethnicity Frequency Percent
Black 22 22.4
White 49 50.0
Latino 13 13.3
Other 14 14.3
(N=98)
Family Demographics
Income Frequency Percent
Low 39 39.8
Not low 59 60.2
Child’s Age Frequency Percent
0-1 24 24.5
1-2 32 32.7
2-3 42 42.8
Needs Frequency Percent
Mild 44 44.9
Moderate 31 31.6
Complex 23 23.5
Service Coordinator Demographics
Employment Frequency Percent
Part time 28 36.8
Full time 48 63.2
Experience (years) Frequency Percent
0-1 12 15.8
1.1-5 36 47.4
5.1-10 21 27.6
10.1-15 4 5.3
15.1-20 2 2.6
20.1+ 1 1.3
(N=76)
Interview Findings
Identified outcomes important to families.
Identified who assisted the family in achieving the outcomes.
Learned how service coordination helped achieve the outcomes.
Identified how long it took to achieve the outcome.
Outcome Methodology
Independent sort of family and SC outcomes into themed categories.
Collapsed similar themes resulting in 14 family and 13 SC outcome themes. Frequencies and percentages were calculated for each.
Second sort of outcomes into themed categories. Frequencies and percentages were calculated for each.
Comparison of interview, Delphi, and survey outcomes yielding final 8 outcomes.
Interview Outcomes
• Children will have successful transitions.
• Children and Families receive early intervention services that are individualized, coordinated and effective.
• Families make informed decisions about services and opportunities in the community for their children with a disability.
• Families acquire and/or maintain a quality of life that enhances their well-being.
• Families are self-sufficient.
• Families are knowledgeable of their child’s disability.
• Families are satisfied.
• Children’s development is enhanced.
• Children are safe and healthy.
Interview Outcomes
FAMILY CHILD SYSTEM
Families are knowledgeable of their child’s unique needs
Children are safe and healthy Children and families receive quality early intervention services that are coordinated, effective and individualized to their needs
Families have tools, knowledge and supports to access resources to address their individual needs
Children’s development is enhanced Transitions are successful
Families acquire and/or maintain a quality of life that enhances their well-being
Families make informed decisions about services and opportunities in the community for their children
Interview Outcomes: Families vs. Service Coordinators
020406080
100120140160180
Decisi
ons
Qualit
y of
life
Sufficie
nt
Know d
isabi
lity
Develo
pmen
t
Safe/
heal
thy
Tran
sitio
ns
Recre
atio
n se
rvice
s
Family Interviews: 98
Service Coordinators Interviews: 98
“Who helped make this happen?”
0
5
10
15
20
25
30
35
40
Family ServiceCoordinator
ServiceProvider
Doctor Other
Family Interviews: 98
Service Coordinators Interviews: 98
Practice Methodology
Independent sort of family and SC practices into themed categories.
Collapsed similar themes resulting in 15 family practice themes and 14 SC practice themes. Frequencies and percentages were calculated for each.
Consensus coding and reliability checks were conducted during the second sort.
Themed categories were compared to practice themes from the Delphi study and reduced to 12 interview practice themes.
Interview Practice Themes
1. Providing families with information
2. Assisting families with obtaining formal and informal supports
3. Coordinating services
4. Monitoring the provision of services
5. Providing support and encouragement
6. Giving suggestions to enhance child development
7. Completing administrative duties
8. Providing direct service to child
9. Facilitating transition process
10. Facilitating communication among team members
11. Developing and reviewing IFSPs
12. Ensuring family understanding of child development
Interview Practices: Families vs. Service Coordinators
0
50
100
150
200
250
300
Pro
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Family
SC
N=98
IFSP Methodology
•98 IFSP’s were available
•68% of IFSP’s had missing data
•IFSP’s were reviewed for-Number of agencies involved, -Team members -Types of services -Location of services-Outcomes
IFSP Data Graph – Agencies used
0
10
20
30
40
50
60
70
1 2 3 4 5 6
Number of Agencies
Num
ber
of
Fam
ilies
20
1016
8
62
IFSP Data Graph – Location of service
01020304050607080
Cente
r
Clinic
Comm
unity
Site
Day C
are
Home
Other
Missin
g I n
form
atio
n
Perc
en
tage
8.9% 2.32% 3.86% 7.34%
67.57%
0.77% 9.65%
Convergence of Data Sources
LOGIC MODEL
State Strategic Planning
RTC
Colorado Ohio
North Carolina Florida
Strategic Planning Process
Vision
Mission
Objectives
Resources
Action Plan
Evaluation Plan
For More Information
•UCEDD Web Site:
http://www.uconnced.org/Data ReportsNewslettersProject Updates
•Articles
•Trainings