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, MC6222 Farmington, CT 06030 USA Phone: (860) 679-1500 Fax: (860) 679-1571 [email protected]Website: www.uconnucedd.org Research & Training Center in Service Coordination CFDA # 84.324L
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Research & Training Center in Service Coordination CFDA # 84.324L
Research & Training Center in Service Coordination CFDA # 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, MC6222 Farmington, CT 06030 USA - PowerPoint PPT Presentation
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Service Coordination: Are We There Yet?
Gloria Harbin, Ph.D.Kathleen Whitbread, Ph.D.
University of Connecticut A.J. Pappanikou Center For Developmental Disabilities
879 EI program practitioners and directors and parents of children with disabilities in 48 states
-519 Program practitioners and directors
-360 Parents
Five Outcomes were identified asprimarily desired benefits of service
coordination -System Coordination -Information and referral -Family support and resources -Family-centered practices -Teaming
Two outcomes were valuedOutcomes of all three services:
-Family satisfaction -Improved quality of life
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)
Practice Focus Group Design
Four Focal States
Connecticut, Indiana, North Carolina, Massachusetts
Large and Small Group Activities Introduction to Service Coordination Discussion of the tool kit available to Service Coordinators Discussion of practices that would lead to quality service coordination
Facilitation Guide“What do service coordinators have to do in order to reach the best
outcomes for children and families?”
Workshop Method
Practice Focus Groups
Sampling Findings
39 Focus groups consisting of participants in 4 stakeholder groups
Parents Service ProvidersService CoordinatorsProgram Administrators
2000+ practices that lead to outcomes of high quality service coordination
Used to develop the Delphi survey instruments
Delphi Practice Sampling
112 PTIs distributed to 12 families each
2688 surveys distributed to families
Total of 4730 surveys were distributed nationally
Part C Coordinators50 states + 3 territories
106 total surveys
Program Administrators8 per state
848 total surveys
Service Coordinators8 per state
848 total surveys
Service Providers8 per state
240 total surveys
Practice Delphi Design and Findings
Delphi I Design
1. Practice lists for each stakeholder group coded by state and stakeholder group.
2. Included practices and outcome statements from both sets of focus groups.
3. Match practices to outcomes on their stakeholder survey.
Delphi I Findings
Frequencies of practices calculated for each outcome statement.
Development of National Delphi Survey.
Practice Delphi Design and Findings
Delphi II Design
1. List of practices that support each of the outcome statements. 2. National sample of stakeholders (Part C Coordinators, Program
Administrators, Service Coordinators, Service Providers, Families) completed two practice surveys.
Delphi II Findings
Practices that lead to the outcomes.
Retained practices that >85% rated as “agreed” or “strongly agreed”.
Yielded 142 practices.
Coded into 12 themes.
Delphi Practice Themes
1. Providing information
2. Ensuring family understanding
3. Being responsive to families
4. Developing IFSPs
5. Monitoring progress
6. Ensuring family satisfaction
7. Promoting child development
8. Addressing healthcare and safety issues
9. Completing administrative responsibilities
10. Planning for transitions
11. Collaborating with community organizations
12. Engaging in professional development activities
Little or no attention is paid to non-EI services provided by EI programs
Transition planning is not reported frequently by families.
National Family Sampling:
358 parents of children with disabilities in 45 states
SCs engage in discussion of EI services but engage in considerable less action oriented practices.
Very little attention is paid to child development and learning.
Objective 4
HOW WE DID IT:
Measured outcomes and practicesof effective Service Coordination
WHAT WE DID:
Interviews with families, families’service coordinators and IFSP review
Interview Design
Four Focal States
Connecticut, Indiana, North Carolina, Massachusetts
Additional States
Arizona, Utah, Washington State
Interview Protocol
Semi-structured questions
Probes
Interview Form
Interview Sampling
Connecticut, Indiana, North Carolina, Massachusetts
IFSPsN=80
FamiliesN=80
Service CoordinatorsN=80
Ethnicity
Child’s age
Child’s level of functioning
Family location
Socio economic status
Full or Part-time employment
Caseloads
Years experience
Amount of training
Interview Sampling
Washington, Arizona, Utah
IFSPsN=30
FamiliesN=30
Service CoordinatorsN=30
EthnicityChild’s ageChild’s level of functioningFamily locationSocio economic statusESLMaternal age less than 17TANFTitle VTANF & Title V
Full or Part-time employmentCaseloadsYears experienceAmount of training
Family Demographics
Location Frequency Percent
Urban 37 37.8
Suburban 36 36.7
Rural 25 25.5
Ethnicity Frequency Percent
Black 22 22.4
White 49 50.0
Latino 13 13.3
Other 14 14.3
(N=98)
Family Demographics
Income Frequency Percent
Low 39 39.8
Not low 59 60.2
Child’s Age Frequency Percent
0-1 24 24.5
1-2 32 32.7
2-3 42 42.8
Needs Frequency Percent
Mild 44 44.9
Moderate 31 31.6
Complex 23 23.5
Service Coordinator Demographics
Employment Frequency Percent
Part time 28 36.8
Full time 48 63.2
Experience (years) Frequency Percent
0-1 12 15.8
1.1-5 36 47.4
5.1-10 21 27.6
10.1-15 4 5.3
15.1-20 2 2.6
20.1+ 1 1.3
(N=76)
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.
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.
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 child’s disability.
• Families are satisfied.
• Children’s development is enhanced.
• Children are safe and healthy.
Interview Outcomes
FAMILY CHILD SYSTEM
Families are knowledgeable of their child’s unique needs
Children are safe and healthy Children and families receive quality early intervention services that are coordinated, effective and individualized to their needs
Families have tools, knowledge and supports to access resources to address their individual needs
Children’s development is enhanced Transitions are successful
Families acquire and/or maintain a quality of life that enhances their well-being
Families make informed decisions about services and opportunities in the community for their children
Interview Outcomes: Families vs. Service Coordinators
020406080
100120140160180
Decisi
ons
Qualit
y of
life
Sufficie
nt
Know d
isabi
lity
Develo
pmen
t
Safe/
heal
thy
Tran
sitio
ns
Recre
atio
n se
rvice
s
Family Interviews: 98
Service Coordinators Interviews: 98
“Who helped make this happen?”
0
5
10
15
20
25
30
35
40
Family ServiceCoordinator
ServiceProvider
Doctor Other
Family Interviews: 98
Service Coordinators Interviews: 98
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.
Interview Practice Themes
1. Providing families with information
2. Assisting families with obtaining formal and informal supports
3. Coordinating services
4. Monitoring the provision of services
5. Providing support and encouragement
6. Giving suggestions to enhance child development
7. Completing administrative duties
8. Providing direct service to child
9. Facilitating transition process
10. Facilitating communication among team members
11. Developing and reviewing IFSPs
12. Ensuring family understanding of child development
Interview Practices: Families vs. Service Coordinators
0
50
100
150
200
250
300
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Family
SC
N=98
IFSP Methodology
•98 IFSP’s were available
•68% of IFSP’s had missing data
•IFSP’s were reviewed for-Number of agencies involved, -Team members -Types of services -Location of services-Outcomes