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HomeMy WebLinkAboutEI Provider Meeting Minutes 10-25-13Early Intervention Provider Meeting Friday, October 25, 2013 Staff: Trish Elliott, Ashley McCartney, Jennifer Johnson Providers: Holly Whiteside, Natasha Kara & Matt Yingling (SAM, Inc.), Jenn Hawbecker & Cynthia Bosserman (UCP), Adam Roland (Advanta) Conference Call: Megan Lesko (Building Blocks), Theresa Miller (Invo Healthcare) Absent: Rick Wynn, Ed Franchi Meeting Minutes Welcome & Introductions were completed.  SAM Introduction by Natasha Kara. It was suggested by the program monitor of SAM that Natasha do an introduction to providers about SAM and their philosophy. Natasha shared that she wishes it would have been done earlier. SAM began providing EI services in Franklin and Fulton on 2/28/13. There has been a slight change of how SAM does EI Service Coordination than it was traditionally done by the County, hopefully a positive change to support the children involved in the services. SAM shared that they feel as though they inherited very good staff from the county, especially from Early Intervention. The EI Supervisor, Holly, does very well in her position as the EI SC Supervisor. EI staff was very knowledgeable coming to SAM. SAM as a larger agency is also learning from the staff that came from the county regarding Early Intervention. SAM does see the children involved in services more than when the County provided EI services. The SAM philosophy is that SAM “works the case” in all of the programs. SAM values the infants/toddlers in the programs and views themselves as an active member of the team for EI services. Their agency’s priority is to assess, advocate, and support the individuals they serve. SAM is more involved by attending more meetings to get more information about what is being done with/for the children. SAM is a contracted provider just like those providing therapy. The contract for EI services is based on being the professional coordinating the services and understanding the services that children involved in the EI system receive until the children graduate from the EI program. SAM’s goal is to communicate more with other providers without interfering with the other services that are being provided. Service Coordinators do need to be present to monitor if the current outcomes are working for the family or if therapies need to be increased ,decreased or a new outcome established by the team. This will help the Service Coordinators know when a family will be requesting an increase or a decrease for units and the reason why, because the Service Coordinator is so involved with the child. SAM’s goal is to be able to answer all of the program monitor’s questions regarding a request for an increase or a decrease in units. Jenn Hawbecker (UCP) expressed that therapists have shared concerns with why Service Coordinators are attending more therapy sessions than before. Her therapists have been told by the SCs that they were there because they needed to get units. Jenn thanked Natasha for sharing the reason why units increased. Natasha explained that she has had a discussion with the SCs that it is not about units; it’s about working the case. The “SAM way” is to go above and beyond and not do the bare minimum. SAM has a CARF accreditation, which is a very high standard to meet. Expectations are set very high. When SAM comes in to a new county they like to add someone who already knows the SAM way to teach the other staff the SAM philosophy and to act as a model. The message is not that the units need to be increased but that they need to be supporting the families in a way that the families need supported. SCs need to understand requests for therapy. The goal is that SCs know everything about the family regarding why the therapy sessions need increased and decreased. Jenn asked if the SCs are meeting with the families when the therapists are not going. Additionally, therapists are confused if they are being monitored or if it is just a home visit. It is not clear to the therapists when the official monitoring meeting is being done. She also suggested that sometimes it is better for the SC to speak with the family alone. For example, if the family likes the therapist it may be uncomfortable to speak about decreasing services. Natasha shared that there is a difference between an official “monitoring” and simply monitoring a service. The SCs should be going out independently and also when therapy is being conducted. SCs have been told by SAM not to interfere with the therapy sessions. SCs were told to ask the therapists where they can sit or how to support the therapy session best. Jenn explained that the therapists were concerned because sometimes the SCs are present at the therapy sessions but do not communicate or interact. Other times there is active role between the therapists and the SCs. The group agreed that the therapists and the SCs should have that conversation together regarding if the SC is there to play an active role in the meeting or that the SC is there in an observational role. SCs should be interacting how the therapists want. SCs and therapists need to increase communication in regard to the purpose of the meeting at hand. Jenn is working with her therapists to address this, so are Natasha & Holly. Success or concerns need to be pointed out and shared. The team needs to work together for the best interest of the kids. Megan Lesko (Building Blocks) wanted to share that she has heard from families that move from Franklin to other counties and they have said they liked the involvement that was provided in our county. Adam Roland (Advanta) asked SAM what is the criteria to determine how often SCs need to attend sessions. Natasha explained that each case is independent, individualized, and team driven. Some children need more than other children. The communication really needs to increase. That is a conversation to have with the therapists, SCs, and the family. It is also important for Ages and Stages to be discussed. Jenn expressed that because SAM is new to the area it is going to take time for the therapist and families to adjust to the increase and change in the support and the new way things happen. Before the SCs were there less and now there is an increase. Traditionally the SCs came only to the mandated monitoring’s. There is going to be a learning curve. It is SAMs hope that the SCs are not forcing themselves on the therapy sessions. If the families do not want too much involvement, SCs need to be respectful of that. There need to be more conversations between everyone so that the families aren’t feeling that the services (service coordination and/or therapy) are being forced. Theresa (Invo) shared the therapists like that the SCs are more involved. She agreed that there was an adjustment period and that the therapists need to learn that it is the new norm, not that the SCs are trying to “catch” them doing something wrong. Theresa commented that Holly is an amazing supervisor, “runs a tight ship”, and provides a great example for leadership. Theresa believes that human nature led the therapists’ to believe that SCs are trying to “catch” them doing something wrong. They are now learning that the process is new and different, since the transition from the County to SAM. Holly shared that the SCs initially questioned how the “new” way of case management was going to work for them, too. Feedback from SCs has been nothing but positive regarding therapists since the transition to SAM. The SCs feel that they are able to respond more quickly and also feel they are able to put in new outcomes, if necessary, without being in the mandated monitoring. Holly also shared that SCs are to be the lead for the IFSP meetings and transition meetings. SCs run the meeting so they were not able to observe the therapy sessions at those times. Now when there are additional visits, they are able to observe the therapy sessions and feel more organized and more involved with the families. Compared to other counties we do have more face time. Ages and Stages had been mailed out in the past but not returned by the families. SC’s are n doing them face to face and there are more Ages and Stages completed. Change is hard but adaptations have been made and worked out. SCs are positive and feel like they are better case managers because of it. SCs and Holly also feel as though Building Blocks evaluations are going well. Natasha has not heard anything negative from the SCs regarding their involvement with therapists’. As a part of SAM’s Corporate Compliance, Holly does surprise visits when SCs are at the families’ homes. During those visits, Holly sits and observes the kids. Supervisors need to make sure that the SCs are where they say they are. It is supposed to be a surprise visit to be sure that no fraud is going on. They are not there to check on the SCs not the therapists. Holly tries to go to the mandated monitoring or evaluations so that she is not just an extra person there during the therapy session. Natasha shared her business cards and phone number for any questions: 801-8984 and nkara@sam-inc.org. Natasha does prefer email. Trish reported that yesterday she attended TA planning with Lincoln Intermediate Unit and Beth Fairchild, Early Intervention Technical Assistant. The focus was on transition. Later in the day she had a meeting regarding LICC where they also talked about transition. She feels like today we made a transition ourselves because of increased communication and knowing what is going on. Trish’s job is to make sure that things go smoothly. She is hopeful that the conversations today were constructive and encouraged everyone to call with any questions.  Changing how we do units and authorizations Trish explained that several of the providers in our county work in other counties as well. Trish would like to have providers call her and have a small committee on how to improve the authorization process in our county. Holly would be happy to be a part of how the service can be provided. We would like to compare and perhaps talk about other ways that we can change our program to improve. If anyone has any ideas about how the group can benefit to better support the children are asked to call. Providers agree that it can be more user-friendly. All the therapists need to do is call Holly to request units be changed. SCs and therapist are both trying to monitor the service delivery, cancellations, therapy provided, duration, frequency, etc. During a prior audit, there has been a finding because the plans were all very similar. Holly explained that now the SCs are really trying to make the plans as individualized as possible. The independent evaluation team should make the decisions regarding outcomes and if a child is found eligible based on the findings of the tool. The Sc then conveys that information to the family and asks if they are ready to develop an IFSP (Individual Family Support Plan). Holly agrees that everyone should be on the same page and that the plan is a changing document that can be revised at any time. Natasha added that SAM does not approve the requested units. SAM puts in their authorization requests and then Trish approves or denies everything. SAM has to justify the requests and understand why the units need increased or decreased. Jen Johnson added that the EI budget separates case management from the various therapies. Holly added that service coordination is an estimate because of the needs of the child. Pelican is a best guess. SCs either bill the county or MA. She also encouraged providers to contact her with questions if there is a concern with an SC or a child. Specific names are helpful to look up so that she can address specific situations with her staff so that specific issues can be addressed. The group was encouraged to call Holly, Matt, or Natasha with specific names of individuals or SCs. If there is an issue with a SAM SC, then they need to know so that the staff can be coached and able to provide the best possible service.  Battelle 2 There will be training on the Battelle 2 at the Old Senior Center at the Administrative Annex on November 8th. Therapists may have to administer this tool themselves sometime in the future. It is a work in progress. Trish is aware that Holly has concerns and suggested that there is a pilot program. Trish has talked to other counties about using the Battelle 2. Trish has been in contact with other counties and the IU who is using Battelle 2. Because the IU also uses this tool there would be consistency for the families. Trish is working with the technical assistance. Holly and Trish will meet with them at the Leadership meeting regarding how it will look and how to introduce it. Trish wants to be sure that everyone is comfortable using the Battelle 2. Positive things about Battelle 2: gives you more information overall about the child, you know where they are with their milestones and developmentally, and it will help to identify other children that EI should be working with. Dauphin County had been contacted for feedback. They explained that it takes longer when you first start and at first the SCs didn’t like it but now that they are seeing all of the information that it gives that the SCs are starting to like it more now. Jenn asked about the specialized tests. Will the Battelle 2 only be accepted or will other testing be accepted? Trish stated that other tests will be accepted based on the child’s needs. For those aged 0 to12 months, Battelle 2 has clear results but older children may need additional testing. Trish went to the evaluation training and it was confusing so that is something that needs to be worked on. Holly explained that they are currently using the DAYC2 with age equivalency as the standard to qualify a child for EI. Several months ago the team tested out the DAYC2 using standard score/standard deviation and almost half of the children would not have qualified with SC/SD under the DAYC2. Holly was concerned that kids would be missed using SC or SD with the DAYC2. Informed clinical opinion should be utilized too. It is important to find out what the good tool is. Holly would like to pilot the tool with the two most experienced SCs to see how it goes. The therapists will also need to understand the Battelle 2. Trish understands that the county used to use this tool and Megan has used it in the past. Holly would like to use it for a few months then get feedback from everyone with the team. Jenn asked if there will there be a copy that the therapists can borrow and use. Trish explained that she will purchase 2 copies of the entire Battelle 2. There is a large cost with the Battelle 2 purchase and implementation.  New Initiatives Jenn shared that a positive behavior grant was just finished up. The first 2 years were full years of the PBIS grant. The 3rd year was a partial year ending in September. The therapists found that it was helpful to target families who were seeing behavior concerns with children. Social and emotional development was looked at with all children. Three compression vests and 3 weighted vests were purchased. They can be used by any therapist. Trish will know where they can be found and anyone is welcome to use them. They also have books that can help children with their feelings. Jenn provided a list of the available books which will be attached with the minutes. Books include how to calm down, attachment to a binky, potty training, etc. and a variety of literature that therapists might like to use with the children. Some are available in English and Spanish. SCs and therapists are welcome to sign them out. They are located at 550 Cleveland Ave, suite 209. Jenn agency is currently working on a coaching grant. Therapists and providers attended training in June. They were able to purchase early childhood coaching handbooks which talks about working with the families and the therapists and promotes family involvement. Seven (7) therapists from UCP and Invo will be able to have Stacy Ott, go with them to mentor and do home visits with the therapists’ to demonstrate how to involve the family more. The coaching grant participants along with other interested parties will also hold a monthly community of practice meetings. It will be open to everyone involved in EI. It looks at how the EI program can be strengthened through the coaching model. There have been SCs and therapists respond that they will attend the training about the coaching model. Networking time and discussion on how we can support each other for the children we serve will take place after the meeting on the 8th. Trish and Holly reached out to Children & Youth Services (CYS) this week. Holly feels that the meeting was very positive. One of the intake/referrals forms was redesigned just for the local CYS. They offered to complete the Ages and Stages with the families involved with C&Y and enroll the child into Tracking or proceed with an evaluation as needed. Currently C&Y do the ASQ’s and refer when the child shows a possible delay. Holly is hopeful that more children will be reached because of partnering with CYS. ASQ should be done on all children reported to CYS. It should take time off of CYS staff and EI will take responsibility for that. If it works then it will be a great child-find activity. Kids-Fests are participated in, but we want to know how we can reach more children. Adam suggested that EI should consider doing outreach and screenings at Day Care agencies. SAM offered to partner with therapy providers to reach the day care providers. It appears that some children are not getting reached until children are 4, they should be screened before that to start therapy. Child care directors need to get on board because the parents need to provide consent for the children to be evaluated. LICC already has 2 participants from 2 day cares. It was suggested that those Day Care Agencies is where it can be started.  Fiscal/Budget Updates Ashley:  Providers have not been returning their projection sheets once their monthly billing has been completed. The sheet reflects the actual billing costs and the projections for the entire year. If anyone needs help on using the spreadsheet, please contact ED or Ashley. If anyone needs to have the spreadsheet emailed to them, again please let Ed or Ashley know. Some providers are submitting it while others are not. Some September bills are still coming in. We are going to evaluate after September where all Provider’s stand for the FY to ensure we have funding to ensure payment through the end of the year. If additional EI funding is needed then we need to advocate early in the fiscal year for more money and demonstrate the reasons why we need additional funding from the State. The county is still waiting on a response from the State for fiscal year ‘12-’13 3rd re-budget to see if we are getting additional funding to cover the expenses from that year.  Miscellaneous  Jen Johnson encouraged providers to have their fiscal staff attend the Provider meetings as there are often items on the agenda that are fiscally related.  Trish and providers will be attending an Early Intervention Leadership Conference in State College in the near future.  OSI does printing and recycling. Providers are encouraged to use this local resource. Flyers were distributed. THE 2014 EARLY INTERVENTION PROVIDER MEETING DATES, TIMES, AND LOCATIONS WILL BE EMAILED OUT AS SOON AS POSSIBLE. The meeting was adjourned. Minutes by Jennifer Johnson