Wednesday, August 11, 2010

Notes from ICC meeting 8/11/2010

Family Voices shares the following notes taken by a FV member at the ICC meeting August 11, 2010. These are not official minutes, but rather the personal notes:
ICC Notes 8/11/2010, 10a-3p; ProKids Office
New members: Susie Lightle (new acting chairperson), Danny O’Neill (parent), and Robyn Nelson (parent)
Schedule next year’s meetings: Possible dates: Nov. 10 (location TBA), Jan. 26, May 11, Aug. 10
Discussion
A. Council Workgroups: Define groups and determine next steps.
Review old workgroups and decide if they’re still needed
1. Advice and Assistance to lead agency (chair Paul Hyslop)—never met so not needed
2. Strategies to Promote parent knowledge, et al. (chairs Phyllis and Sarah) Extremely important (parent comment) but the chairs are not here, so defer to later meeting for decision rather than dissolving it.
3. Statewide Consistency with Best practices: Looks at service levels, still a need. This group should continue. Statewide Consistency (quality and assessment): More consistent policies throughout the clusters. This group should continue.
4. Statewide Transition (Donna Driscoll): Has not done much lately. LEAs have had some problems with Head Start. Becky Haymond: Transition to LEA or Head Start is not a SPOE issue. This is a Service Coordinator issue, by cluster. Consensus: Dissolve the group and Susie and Betsy Traub become liaisons to ICC. Susie could be a liaison between this group and the ICC to get a report on DOE transition team and what they’re doing.
B. Survey—Michael Conn-Powers reported that the survey for families exiting FS is still in process, pending final approval from Dawn.
C. Child Find: Status of child find for FS (data review, research, other entities/challenges): Dawn Downer reports there’s been considerable discussion on this. In 2009, we did see a continued increase in numbers served (published online in Profile reports). Almost 21,000 with IFSP, evaluated and served (not eligible or did not choose to receive services) almost 25,000. These numbers are becoming more stable, but it is more kids than expected with changes to eligibility in 2006 (note: does not include kids who were referred but declined at intake). In fact, it’s 25% more than expected. Analysis in progress. In general, eligibility is being determined relatively consistency and that adequately represents eligibility. With that, SPOEs have seen a increased referrals. Where are the referrals coming from? There hasn’t been a significant change in the FS systems, but on the provider and medical home side of things there is a strong push for referrals of young children suspected of having PDD or ASD. Continue to try to ensure that ED teams are being consistent with handling of eligibility determination. No action requested at this point. Parent (Molly Kitchell) question: What are the numbers for eligible but parent declined vs. not eligible. Dawn says she’ll get those numbers. Becky Haymond: Substantial abuse and neglect kids—is this going to raise our numbers? Ages and stages is handling this and is doing a screening prior to evaluation to save time and money. Jamie suggested a screening both initially and again after 3 weeks or so in the new nurturing foster home environment to see if there is a significant change and prevent unnecessary evaluations. Screenings will be completed by a consistent caregiver, possibly facilitated by caseworker, and FS would mail the screening results to SPOEs.

Approved February Minutes. Approved May Minutes.

State Updates (Dawn Downer)
A. Status of Cost Participation Legislation, Documentation: Cost participation—parent contributing to cost of services. Those fees are determined on sliding fees scale 70% do not have a co-pay (at or under 250% of poverty level). 50% of families are on Medicaid. The remainder 30% have co-pays based on their income, deductions are considered for health care and personal needs expenses. The other piece is allowing the state to access private insurance, but sometimes FS gets a TPL insurance payment and sometimes not, which can be used to re-calculate cost participation. Trying to determine the most sensible cost participation plan for each family. Currently there are some families that choose to not pay their copay in a timely manner or at all. Of the 30% that have a co-pay, 20% are generally not current with their bill, and there are a number of reasons for being behind on co-pays (parents just don’t pay, don’t see it as important, are waiting for insurance to pay, etc.). If it is a reason that is a hardship (a reduction in the income, additional family member, etc., FS will work with the family to make arrangements for the most reasonable copay for that family. What to do with the accounts that are not getting paid, 60+days. When a family reaches this, SCs need to be more involved with that family to figure out what’s going on (change in income, help them set up a payment plan, etc.). If there is no good reason for non-payment, FS will take action to suspend services. FS collects just under $1M/year and about $200,000/year that FS does not recover because families do not pay. Note that FS has not yet taken steps to suspend services for any families. Feds have approved family letter, some changes to letters for parents to know what their rights are. Statements that go out at the end of this month include a reminder of the policy, and to contact their SC if they have any concerns with their bill. Suspension notices will go out to parents with September statements and a suspension date, with info on how to prevent suspension of services (contacting SCs, etc.). There are 56 families that currently fall into this category. Donna: What is the procedure to notify providers of a suspension? Dawn says there’s no perfect system yet, but for now every month, SPOEs will get a list of families who have fallen 60+days behind and are in danger of suspension. SPOEs will need to follow up with the family, and will need to notify providers. Donna: What happens when family claims that they did not get the letter, and the SPOE calls. Dawn says the families should still have time to correct the problem before suspension of services. Becky: What’s the procedure and timeline for training SCs on how to counsel families and is there going to be consistency across clusters? This Friday 8/13/10, a letter will go out to SCs, similar to ones in the past but strengthened language on rights and procedural safeguards. Each SPOE has a supervisor trainer (10 of them), which are responsible for training their staff for consistency with the policy. Becky indicated that the SC work group could discuss how to ensure consistency with providing info/counsel to families and with notifying providers. SCs and SPOEs will not be making the determination to suspend services; that will all be handled at the state level. If a family misses its suspension payment due date but then makes a late payment, the family has an option to continue with IFSP but cannot be ensured the same providers (because providers may have already taken on a new family).
B. Updates of importance.
1. For eligible kids, the next step is to ensure that kids are having their needs met and getting quality service with best practices in a way that is cost-effective. Gayla: Is there a trend toward more kids qualifying for eligibility earlier birth – 18 months? Dawn: No, most are coming in about 18-20 months, but we’re tracking this from birth-1year. There is a 1-day child count, race/ethnicity. We did not quite meet that goal, but it is not an alarming difference, and the feds have not seemed alarmed either. Jamie: What can clusters do differently? Dawn: Nothing at this point. With ED teams, kids are on the cusp of eligibility, we would prefer that the ED teams advise the parents to watch for certain developmental milestones to happen in the next 3 months and then possibly re-evaluate at that time.
2. FS moved to new building, upstairs with DDRS. Closing out last fiscal year, with 60 days to balance everything out, planning for current fiscal year (July 1). DDRS goal to meet fiscal responsibilities that still serves well families, providers, SPOEs and communities. How do we maintain quality services in a fiscally responsible, sustainable way? FS is looking at different options, stakeholder meetings (nothing finalized). Unlike with 2006 changes, we cannot take as much time to implement changes.
3. Personal note: Dawn says she feels very comfortable at this point with changes being discussed, although there are significant challenges. She is very open to ideas and suggestions to achieve this goal, and welcomes emails and comments to that end. Jamie suggested that people at all levels have input to these changes to better ensure that they will work for everyone. Dawn says that they’re looking at dates to get feedback from ICC, because ICC does have broad representation. Becky: Is there a projected timeline? Dawn says that they’re already behind, and are even considering an emergency meeting before November with ICC. For some of the changes, nothing has been decided because we haven’t yet sought counsel from others. Nothing is settled, but there are some policies that are already in place and just need to be implemented to hopefully effect cost-savings by Sept. 1 ideally. Becky: All communication, especially of any policy changes, and even re-iteration of best practices, needs to be in writing on a timely basis and consistent to all SPOEs. Dawn says that the governor has been painstakingly looking at all state agencies $70M program. From the feds, we get just under $8M, leaving a $62M deficit ($6M from state). Even with those two grants (only the two guaranteed). What other appropriate funding streams are out there to support the cost? Average number from years’ past, we have a $56M deficit. Medicaid--$9M approximately, leaving $47M. TANF (state and federal, numbers have not been finalized for coming year): $18M total, leaving $29M. Almost 50% of FS kids are eligible for Medicaid, so we get a cost allocation for things like SC, etc., from Medicaid was well, about $6M, leaving $23M. Cost participation: $1M, leaving $22. TPL (Party liability): hoping for $4M+, leaving $18M. Stimulus fund: $4M, leaving $14M deficit. And that’s it. Where does the remainder come from? The answer: from another program. Dawn says she is committed to minimizing that “borrowing” from other programs while still maintaining the quality of services that our families deserve. Gayla: With kids who overlap with FS and early Head Start, are we examining who is responsible for paying for the therapy for the child? Dawn said it was something we definitely should take a look at. Melissa Hahn: Also we could re-evaluate what level of FS services is really needed for a child if that child is also being served by Head Start. Dawn says a summary is that we’re working closely with FSSA and DDRS to share cost-savings ideas, and then pulling together stakeholders to help find the holes. If the hole is truly detrimental, then we need to take a serious look at it. We do not want to deny services to those who truly need them, but must have sustainability in mind. Come 2011, we hope to have settled in to a “new normal.” Susie: When is the emergency meeting to be held? Dawn will finalize dates this afternoon—2-3 weeks from now. Jamie: Is this a work group to make comments on the proposals? Dawn says that it is more of a discussion of where are the holes? Julie Holloway: It’s going to be a presentation of the proposal. Molly (parent): Can we have some information about this proposal ahead of time to review and think about it? Dawn claims this is a public meeting, and that she’ll see if it’s possible to provide more info before the meeting. Following this meeting, the emergency meeting will be set by Dawn, Suzie, and Betsy.

LPCC Presentations
A. Cluster C (Elaine Armstrong): Newly formed in April with 4 counties. LPCC structure had to be re-designed. Re-structuring committee met frequently to get membership quota up to part, bylaws developed, committees planned. Great progress has been made. Should meet membership quota/parent quota by upcoming meeting. Note from Dawn: LPCC (FS councils), 10 service area, child find, provider recruitment, best practices, defined by regulations. 20% of their members have to be parents. Elaine: Early stages of child-find committee, provider relations, oversight/quality committee, transition committee. Next quarter, getting committees together. Working with Cluster B on hospital NICU referrals.
B. Cluster D (Dee Ann Cabell, SPOE director): Tippecanoe and contiguous counties (9 in all, a long cluster geographically). 7 of 9 counties are very rural with low population, with urban centers being Lafayette area and Boone County closer to Indy. App. 600 children in service at any given time. Referral load was 1400 for last year. In Tippecanoe and Boone, low to high income groups, and many low income in the rural counties. Boone county has highest number of families with insurance and therefore copays. About half kids are in Tippecanoe, 20% in Boone, and the remainder in the other counties. Good provider coverage in populous counties, less so in rural counties. About 200 providers on distribution list, many full time providers but also some “dabblers” who may have a very small case load. Strong evaluation team. Cluster D has had several successes: developing a transition memo of agreement that includes every school district co-op. All have bought into this unified transition agreement. On an annual basis, the LEAs, Head Starts, other transition partners attend a meeting with SPOE staff to update all contact info. Good retention of staff and achievement of outcomes. ICC outcome: Improving presence of evaluation team at IFSP meetings: 23 of 26 weeks, 80% of meetings were attended by evaluation team. Strong attendance at quarterly provider meetings. Developed agreement with hospitals to provide FS info to new parents. Challenges: With regard to the cost participation, they are having difficulty with insurance issues with families.
C. Cluster E (Elaine Armstrong): 10 counties located in North Central IN. Unique challenges because it’s a long cluster—2 ½ hours end to end, with LPCC meetings held in the middle of the cluster for convenience. Transition meetings held immediately after. There is also a data team, SPOE oversight, provider workgroups, transition. LPCC coordinator very active. Quarterly provider meetings for updates, guest speakers, etc. Held a successful service provider fair (25 organizations attended) with a FS presentation, lots of collaboration and communication. Community outreach going on to WIC, physicians, church groups, etc.
D. Cluster F (Anita LaSallis): West central IN. When we hold provider meetings, rotate the location to make it more convenient. LPCC meetings near the center geographically. Shifting to be more technologically driven to save money and time. Ongoing transition, provider issues team meet on quarterly basis. Each team has providers, SPOE staff, LPCC coordinator, etc. to bring different perspectives. The ED teams are able to attend 90% of IFSP meetings, striving for 100%. SC caseloads from 60-98, facilitate child find efforts. Surveys for families for evaluation meeting, IFSP meeting, and 6 month meeting, and then annually. 100 providers, some of which are shared across nearby clusters. Challenge with finding qualified feeding specialists. Series of workshops for DTs led by other disciplines (PTs, etc.). Child find efforts: work with resource and referrals, outreach and training for childcare centers to make appropriate referrals, developed portfolio for ED teams and SCs so that they always have the tools, radio spots, etc.
E. Cluster H (Angela Wissler): East Central IN. Main cities: Anderson, New Castle, Richmond, Muncie. Some very rural areas. Increasing Amish population. 1400 referrals last year. Recently re-clustered, combining some intake and SC efforts. Strengths: Good family participation. Satisfaction surveys from intake through transition with 98%+ approval ratings. 15-member staff, averaging 11 years experience with FS. Challenges: Restructuring the council, many new people. Bylaws developed. Growth made new meeting location necessary. Staff had to adjust to work from home. Continuing challenge: bordering OH, so provider base is limited, as they often can draw on neighboring clusters in the east because of different licensing procedures for providers in OH. Successes: Community partnership efforts strong with representation from many areas. Re-formatted website.
F. Cluster J (Becky Haymond): Highlights: Re-clustered in April to include 18 counties in all. Very rural areas, and urban areas include Columbus and Bloomington. Edges border both OH and KY. Strongpoint: lots of parent information from intake to transition. Parent Intro Handbook includes outline of programs, intake visit, services available, dictionary of terms, etc. When IFSP is complete, welcome packet given with core info, including waiver info, FSF, early literacy, and a complimentary children’s book (funded by a program with a local sorority in 3 counties). There are also county-specific resources provided to each family. Transition packet includes core info, county-specific options including Head Start and preschools, Intro to Special Ed booklet. LPCC re-grouped also.
Adjourned at 1:56pm

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