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Monthly Archives: October 2012

Yesterday I participated in the Children’s Policy Council’s briefing for the Texas legislature.  The Children’s Policy Council (CPC) was established by the 2001 Legislature to help provide recommendations to the state about integrating services to children with special needs to provide the services that are needed in a more effective, cost-effective, and integrated way.   It’s membership is primarily parents of children with special needs, which allows it to provide a unique perspective to the state.  Every even-numbered year, the CPC produces a report with recommendations for the Legislature.  The 2012 report can be found here: http://www.hhsc.state.tx.us/si/C-LTC/2012-CPC-Leg-Report.pdf .

 

The CPC conducted a briefing based upon the recommendations found in the report to the Legislature and state agency employees in the state capital yesterday.   I’m happy to report that staffers from about 25 representatives and senators attended as well as staffers from the Department of Assistive and Rehabilitative Services, the Department of Aging and Disability Services, and the Health and Human Services Commission.

 

I discussed the need to fully fund Early Childhood Intervention (ECI).  I have covered a lot of the issues elsewhere (see: http://wp.me/pZf7K-7F for the most recent summary), but none of the CPC assumed knowledge on the part of the people attending the briefing.  I began by discussing what ECI is and what it does.  I explained that there is a narrow window (birth to age three) when services can be provided to children that might be less expensive and easier due to the fact that children are developing rapidly at this age.  Failing to address delays at this age doesn’t make them go away, it makes them someone else’s problem (the school districts and society’s) which becomes more difficult and more expensive as the child ages.

 

After that I covered the history.  Namely that the funding for ECI has been cut for several years.  In fiscal year 2010 it was 197 million dollars.  In FY2012 it was 163 million dollars.  In FY2014, DARS is asking for 145 million with an additional 40 million in exceptional items.  The result of this has had an impact on how many children receive services as well as who those children are.  As I have written about elsewhere, I explained the consequences of the Legislature’s short-sightedness with ECI and explained why it needs to be fully funded.

 

With one exception, all of the other presenters at this briefing were parents.  This was powerful as it provided a human face to the services and programs that the CPC is recommending.  One of the parents, Cheryl Fries, began her presentation by talking about her “D Day,” the day her family received the diagnosis of their child’s disability.  She told those attending the briefing that each parent of a special needs child has their D Day burned into their memory and that none of us asked to be part of this club, but we’re all members nonetheless.  I thought that was a powerful statement and I’m going to borrow that in the future.

 

The one exception was Dr. Carl Tapia, who is a pediatrician specializing in children with special needs.  He discussed the CPC’s recommendations for reforming acute Medicaid services.  The CPC has been involved in making recommendations to the state about redesigning both long term services and supports as well as acute Medicaid services.

 

I found the briefing to be a positive experience.  We had a good turnout and I felt that they were attentive and asked questions.  Now how things play out during the upcoming session is anyone’s guess…

Yesterday (10/10/12) I attended the Early Childhood Intervention (ECI) Advisory Committee quarterly meeting. There were several interesting items that came up in the meeting:
• Report on family outcomes
• Consequences to the system changed to ECI in Texas
• Providers of ECI in Texas

Family Outcomes
The Department of Assistive and Rehabilitative Services (DARS) ECI staff does an annual report to the federal Office of Special Education Programs. Among other things, ECI reports on three family outcome indicators:
1. How helpful has ECI been on helping families know their rights?
2. How helpful has ECI been for communicating their child’s needs?
3. How helpful has ECI been in helping the child to develop and learn?

Each indicator is made up of 6-8 questions. These indicators are measured via a survey that is conducted amongst half of the ECI providers in December.

For the fiscal year that just ended (FY2012), the three indicators declined relative to the year before, though they all met the targets that the state has set. Drilling down into the indicators, it appears that three concerns were responsible for this decline:
• Transition education from ECI to the next stage
• Education about the range of services available to the family and the child
• Helping children get along with others: in terms of behavior but also in terms of things like day care placement

There are two cautions about this survey and its results. First, the timing is important. This survey went out just as the system-wide changes to ECI were really beginning to kick in. It’s unclear our reflective these survey results are of the situation today, a year after the system-wide changes were implemented. Second, the sample size is incredibly small. These survey results are based on 943 responses. In December of 2011 there were 25,035 children enrolled in ECI. With the survey going out to half the programs, there are somewhere around 12,517 potential children in that population (although that is dependent on the size of the programs surveyed). 943 out of 12,517 represent a sample size of 7.5%. Here’s the problem: a sample size that is too small means you are unsure if the survey results adequately reflect the population. Normally when conducting surveys you figure out what type of sample size you need. When I asked about this, I got a deflecting-type of answer.

Consequences of System Changes
The system-wide changes to ECI (narrowing of eligibility, family cost share, provider direct billing of Medicaid, and measureable outcomes) have had effects on providers, families, and children. For the providers, they have been in an identity crisis and have had to gradually shift their focus away from families and more towards business, billing, and measuring/assessing outcomes.

For everyone else, the consequences of the system-wide changes have been complicated. First, by narrowing eligibility fewer children are being served. In FY2010 there were 32,101 children being served. In FY2012, there were 25,035. This is a 22% reduction. Second, by narrowing eligibility the mix of who is receiving ECI has changed. In 2010, 16% of those children were “atypical” in the sense that they were not developing at the “normal” rate. Today that group makes up 3% of the ECI population whereas there are a greater percentage of children with a medical diagnosis or developmental delays. This means that those individuals still receiving services require more intensive services. As a result, the average direct services per child per month has increased from 2.1 hours in FY2010 to 2.7 hours in FY2012 (a 29% increase). It is expected to eventually move up to 2.9. On the surface this sounds positive, but as the population of Texas increases and if funding stays static, it means that fewer children will be able to be served in future years.

Providers of ECI
Since FY2010, the number of ECI providers in Texas has declined from 58 to 51, or a 12% reduction. Of the seven providers that were lost, 3 were independent school districts and 2 were education service centers. In other words, 5/7 of the providers lost were related to the public school system. This is largely because as providing ECI has become more complicated in terms of narrowed eligibility, direct billing of Medicaid, and outcomes assessment the public school system is deciding that this is too difficult given that working with 0-3 year olds isn’t part of their purpose for being here.