Service Coordination: Are We There Yet?

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Research Training Center in Service
CoordinationCFDA 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, MC6222Farmington, CT
  06030USA
• Phone [phone]Fax (860)
  679-1571whitbread_at_nso1.uchc.edu
• Website www.uconnucedd.org

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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

3
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.

4
Center Framework
Family
Service Provision
System Administration
Status
I.
Outcomes
II.
Recommended Practices
III.
Measurement
IV.
Training Model
V.
Dissemination
VI.
Surveys
Focus Groups
Delphi Technique
OutcomeMeasurement
Validation Studies
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Objective 1
HOW WE DID IT
WHAT WE DID
Described current models of service coordination
Series of Surveys
6
Survey Design
7
Survey Sampling
8
Survey Findings
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System Infrastructure

• WHAT IS NEEDED TO SUPPORT EFFECTIVE SERVICE
  COORDINATION

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Case Study States

• Dedicated and Independent
• Blended with Intervention LA
• Blended with Intervention IA

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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.)

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Which Model is Best?

• FINDINGS
• Differences in nature of some system components

SERVICE COORDINATION PRACTICES
SYSTEM INFRASTRUCTURE
CHILD AND FAMILY OUTCOMES
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Which Model is Best?

• Not a useful question
• Multiple factors not just the model were
  associated with positive outcomes

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Approaches and their Assumptions

• ANALYSIS REVEALED
• Assumptions not always realized
• Multiple factors could influence whether the
  original assumptions were realized

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Dedicated Approach

• ASSUMPTIONS
• Can spend more time on S.C.
• Specialist Needed
• Offer Broader Array
• More Choice for Families

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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

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Blended Approach

• ASSUMPTIONS
• Most knowledgeable about child and family needs
• More effectively communicate with other providers
• Family more likely to reveal needs

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Blended Approach

• WHAT CAN GO WRONG?
• Knowledge of needs related to own expertise
• Communication doesnt occur (no time, no
  mechanism)
• Service provider doesnt elicit needs

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Variable Approach

• ASSUMPTIONS
• No model is best
• Locals know best
• Individualization of approach is more likely to
  meet needs

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Variable Approach

• WHAT CAN GO WRONG?
• Pragmatic decision, not data-based
• What locals think is best may not be
• Lack of consistency confuses parents

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Influential Factors

• Empowering Relationship
• Case Load
• Use of Family Support Approach
• Parent Choice
• Array of Resources
• Breadth of Service System
• Interagency Linkages

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Influential Factors

• Integration of Services
• Transdisciplinary
• Routines-Based
• Integrated Therapies
• IFSPs With All Needs and Services
• Interagency Training
• Mechanisms to link needs to resources

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Influential Factors

• Learning Opportunities in Natural Settings
• Identification of New Needs
• Frequency of Contact
• Case Load
• Interagency Linkages

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Influential Factors

• Knowledgeable Personnel
• Diverse disabilities and conditions
• Resources
• Capacity building

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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)
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Outcome Focus Group Design
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Outcome Focus Groups
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Delphi Sampling
Total of 395 surveys were distributed
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Outcome Delphi Design
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Outcome Delphi Design
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Delphi Outcomes

• Children and families receive appropriate
  supports and services that meet their individual
  needs
• Children are healthy
• Childrens development is enhanced
• Children have successful transitions
• Families are involved in decision making
• Families are informed about resources and
  services
• People work together as a team

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National Outcomes Survey
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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)
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Practice Focus Group Design
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Practice Focus Groups
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Delphi Practice Sampling
112 PTIs distributed to 12 families each 2688
surveys distributed to families
Total of 4730 surveys were distributed
nationally
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Practice Delphi Design and Findings
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Practice Delphi Design and Findings
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Delphi Practice Themes

• Providing information
• Ensuring family understanding
• Being responsive to families
• Developing IFSPs
• Monitoring progress
• Ensuring family satisfaction
• Promoting child development
• Addressing healthcare and safety issues
• Completing administrative responsibilities
• Planning for transitions
• Collaborating with community organizations
• Engaging in professional development activities

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National Practices Survey
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Objective 4
HOW WE DID IT
WHAT WE DID
Measured outcomes and practicesof effective
Service Coordination
Interviews with families, familiesservice
coordinators and IFSP review
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Interview Design
43
Interview Sampling
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Interview Sampling
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Family Demographics
(N98)
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Family Demographics
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Service Coordinator Demographics
(N76)
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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.

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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.

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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 childs
  disability.

• Families are satisfied.

• Childrens development is enhanced.

• Children are safe and healthy.

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Interview Outcomes
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Interview Outcomes Families vs. Service
Coordinators
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Who helped make this happen?
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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.

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Interview Practice Themes

• Providing families with information
• Assisting families with obtaining formal and
  informal supports
• Coordinating services
• Monitoring the provision of services
• Providing support and encouragement
• Giving suggestions to enhance child development
• Completing administrative duties
• Providing direct service to child
• Facilitating transition process
• Facilitating communication among team members
• Developing and reviewing IFSPs
• Ensuring family understanding of child
  development

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Interview Practices Families vs. Service
Coordinators

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IFSP Methodology

• 98 IFSPs were available
• 68 of IFSPs had missing data
• IFSPs were reviewed for
• -Number of agencies involved,
• -Team members
• -Types of services
• -Location of services
• -Outcomes

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IFSP Data Graph Agencies used
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Number of Families
16
10
8
2
0
Number of Agencies
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IFSP Data Graph Location of service
67.57
8.9
2.32
3.86
7.34
0.77
9.65
Percentage
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Convergence of Data Sources

LOGIC MODEL
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State Strategic Planning
Ohio
Colorado
RTC
North Carolina
Florida
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Strategic Planning Process

• Vision
• Mission
• Objectives
• Resources
• Action Plan
• Evaluation Plan

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For More Information

• UCEDD Web Site
• http//www.uconnced.org/
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