Easing the Transition from Early Intervention to Preschool-Based Services

1
Easing the Transition from Early Intervention to
Preschool-Based Services

• PDSA Project
• Washington Heights Family Health Center2005-2006

2
Why did we choose this PDSA project?

• Many kids seemed to fall through the cracks
  after Early Intervention expired at the age of
  three
• Familiarize providers about the transition
  process between early intervention and
  school-based services
• Further allow this transition to be as
  uninterrupted as possible

3
Background Early Intervention Program (EIP)

• Age eligibility 0-3 years
• EIP must provide a service coordinator to ensure
  that services are provided year-round and an
  Early Intervention Official (EIO) to help ease
  the transition to pre-school
• An Individualized Family Service Plan (IFSP)
  details all of the services to be provided for
  each referral
• Children eligible for pre-school special
  education can stay enrolled in EIP until their
  third birthday

4
Background Preschool-aged Special Education

• Age eligibility gt3 years
• Patients are deemed eligible by the Committee on
  Preschool Education (CPSE) and must have
  documented disability within an Individualized
  Education Plan (IEP)

5
Background Transition Process

• Begin EARLY! At 2 ½ years of age!
• A transition plan should be incorporated into the
  IFSP by the service coordinator
• Obtaining written parental consent is an integral
  step in the transition process
• Parent must report to regional CPSE office
  with EI exit evaluation and MD-endorsed health
  form

6
PDSA Cycle 1 Pre-intervention chart review

• 12 total well-child visits of children 3 years
  old with a diagnosis of developmental, speech, or
  language delay were reviewed
• 50 had documentation of transition to
  school-based services
• Documentation was non-uniform
• Attendings and third year residents were most
  likely to document school transition

7
Project Goals

1. To improve MD discussion of transition process to
   80 of eligible children
2. To educate at least 75 of parents of eligible
   children about the transition process
3. To document the transition to a school-based
   service (or at least document the completion of
   an intermediate step for at least 50 of eligible
   children)

8
Develop lecture series of background information

• Meetings held with Evelyn Batista, MSW and Dr.
  Harriet McGurk to gather information
• Lectures given (during block 4) to all providers
  during afternoon resident didactic session

9
Develop EI folder to be placed in all provider
rooms

• Contents determined from prior research
• EI folder holds the following useful tools
• MD Information Sheet highlighting critical
  steps in transition process
• Map of educational districts with contact
  information
• List of organizations who provide direct advocacy
  assistance for individual students with school
  problems
• District map also displayed in resident room

10
PDSA Cycle 2 Develop EI sticker

• EI sticker to be used in the charts of patients
  between ages two and three who are EI
  participants and will be transitioning
• Prompts the provider to collect information about
  the officials responsible for the transition
  process
• Prompts the provider to ask about
  parent-participation
• Reminds the provider of their role in the
  transition process

11
First Draft of EI Sticker
EI Service Coordinator
EI Srvcs Continue Thru 8/31 (turning 3 between 1/1-8/31) 12/31 (turning 3 between 9/1-12/31)
CPSE Region District (see map) Region _____ District_____ Phone Number _____________
CPSE Referral Status EI has referred child to CPSE for evaluation Parent has signed consent for CPSE evaluation Evaluation has been scheduled Parent attended meeting about their childs IEP and/or signed a consent agreeing with the IEP Placement will be at ____________________
Provider Action Completed health forms for CPSE eval Asked parent to bring a copy of the IEP Other
Abbrevs EI Early Intervention, CPSE Committee on Preschool Education, IEP Individualized Education Program Abbrevs EI Early Intervention, CPSE Committee on Preschool Education, IEP Individualized Education Program
12
PDSA Cycle 2, contd EI Sticker
Critique/Feedback from Providers

• Add place for signature of provider
• Delete line with abbreviations and format to fit
  sticker size
• Sign-up list placed in resident room with medical
  record number and provider for each new sticker
  placement (to track progress)

13
Second Draft of EI sticker
EI Service Coordinator
EI Srvcs Continue Thru 8/31 (turning 3 between 1/1-8/31) 12/31 (turning 3 between 9/1-12/31) 8/31 (turning 3 between 1/1-8/31) 12/31 (turning 3 between 9/1-12/31)
CPSE Region District Region ____ District_____ Phone ____________ Region ____ District_____ Phone ____________
CPSE Referral Status EI has referred child to CPSE for evaluation Parent has signed consent for CPSE evaluation Evaluation has been scheduled Parent attended meeting about their childs IEP and/or signed a consent agreeing with the IEP Placement will be at ____________________ EI has referred child to CPSE for evaluation Parent has signed consent for CPSE evaluation Evaluation has been scheduled Parent attended meeting about their childs IEP and/or signed a consent agreeing with the IEP Placement will be at ____________________
Provider Action Completed health forms for CPSE eval Asked parent to bring a copy of the IEP Other Completed health forms for CPSE eval Asked parent to bring a copy of the IEP Other
Signature Signature Date
14
PDSA Cycle 3 Formal EI sticker evaluation

• Second chart review conducted to determine
  whether providers are using the sticker, and if
  not, why?
• 5 of 6 residents and 9 of 12 attendings surveyed
• Of 14 surveyed, 6 use the sticker, and 8 admit to
  not using it at all.
• When asked why nonusers decline using the
  stickers, the answers were
• The patient did not fit the criteria to benefit
  for special education services
• I did not know about it

15
PDSA Cycle 4 Assess parental knowledge of
transition process

• Resident called seven parents from patients
  listed on sign-up sheet
• Parents are unaware of the transition process and
  assume that it just happens automatically
• Parents are surprised that we may play a role in
  easing this transition
• Doctora, porque Ud quiere a ayudarme con esto?
• Parents want our help in knowing how to advocate
  for their children

16
PDSA Cycle 5 Interview with EI Coordinator

• Spoke with an EI service coordinator to gain
  insight into reasons why the transition process
  may fail
• Lack of parental consent for CPSE evaluation
• Not receiving the CPSE packet in the mail
• Not responding to the packet
• Misunderstandings about the evaluation
• Social stigmata of special education
• CPSE refuses to provide services

17
PDSA Cycle 6 Interim Review

• Chart review Patients seen between 12/1/05 and
  3/1/06 with primary diagnosis of developmental
  delay or speech delay
• 25 charts reviewed, 15 of these patients fit
  criteria for sticker placement, but only 4 had a
  sticker in their chart (26.6)
• 3 additional charts had written documentation but
  no sticker
• Higher percentage of sticker usage among
  residents than attendings (33 vs 22)

18
PDSA Cycle 6, contd Provider Feedback on
Interim Chart Review

• EI sticker should be used with each initial
  referral
• Sticker should be modified to include the date of
  initial referral

19
PDSA Cycle 7 Chart review to assess sticker
usage in new referrals

• Chart review Charts from patients seen in 2/06
  were examined to see if there was documentation
  of a new EI referral with a sticker
• Nine charts reviewed, three were new referrals
• Of these three, only one had a sticker
  documenting the date of the initial referral
  (33.3)

20
Third and Final Draft of EI sticker
Date of Initial Referral
EI Service Coordinator
EI Services Continue Through 8/31 (turning 3 between 1/1-8/31) 12/31 (turning 3 between 9/1-12/31)
CPSE Region District Region ____ District_____ Phone ____________
CPSE Referral Status EI has referred child to CPSE for evaluation Parent has signed consent for CPSE evaluation Evaluation has been scheduled Parent attended meeting about their childs IEP and/or signed a consent agreeing with the IEP Placement will be at ____________________
Provider Action Completed health forms for CPSE eval Asked parent to bring a copy of the IEP Other
21
PDSA Cycle 8 Final Chart review

• 18 charts reviewed with diagnosis of either
  developmental delay or speech delay of patients
  seen between 3/1/06 and 3/29/06 seven met
  criteria
• Three new EI referrals (all resident patients)
• Two with stickers, one without
• Two in EI ? CPSE transition (one resident, one
  attending)
• Both with stickers
• One EI Re-evaluation (attending patient) with
  sticker
• One Follow-up EI (resident patient) without
  sticker

22
PDSA Cycle 8 Data from Final Chart Review
23
Conclusions

• Sticker usage has improved among attendings and
  residents (gt50 as in initial project goals)
• Providers have become better informed about the
  transition process
• Sticker usage should continue to be encouraged
  because it
• Acts as a reminder for the provider to address
  these issues during a well-child encounter
• Encourages families to view us as another
  resource to advocate for their child.
• Format EI sticker in future Eclypsis system

24
References

• Dr. Harriet McGurk
• Evelyn Batista, MSW
• Elba Moreira, EI Assistant Director of Service
  Coordination
• www.insideschools.org
• www.health.state.ny.us/community/infants_children/
  early_intervention
• www.vesid.nysed.gov

25
Acknowledgements

• Dr. Adriana Matiz
• Dr. Mariellen Lane
• Dr. Daniel Hyman
• Dr. Harriet McGurk
• Evelyn Batista, MSW
• Dr. Teresa Lee
• Dr. Monique Collier
• Dr. Matt Laurich
• Dr. Maria Kim

• Dr. Eliza Auerbach
• Dr. Sarah Shrager
• Dr. Ray Liu
• Dr. Paola Ayora
• Dr. Dawn Wetzel
• Dr. Rachel Salguero
• Dr. Rachelle Gandica
• Dr. Maja Castillo