MINUTES OF UTAH INTERAGENCY COORDINATING COUNCIL (ICC)UTAH
INTERAGENCY COORDINATING COUNCIL
FOR INFANTS AND TODDLERS WITH SPECIAL NEEDS AND THEIR FAMILIES
Utah Department of Health, Division of Community and Family Health Services
44 North Medical Drive, Salt Lake City, Utah
September 19, 2003
Attendance (alphabetical): Cheryl Alexander, Caroline
Bass (via video), GleeAnn Clayton, Kris Fawson, Barbara Fiechtl, Tim Floyd
(via video), Chris Giacovelli, Charlotte Gibbons (proxy for Patty Van
Wagoner), Sherry Hancock, Kristina Hindert, Nancy Murphy, Meredith Mannebach,
Cathy Nelson, Judi Nielsen, Connie Nink, Jill Oberndorfer, Susan Ord,
Gina Pola-Money, Fan Tait, and Mark Valentine.
Excused Absences: Debbie Justice.
Absentees: Calvin Bird, Diana Sagers.
Visitors Present: Trisha Beck, George Delavan, Joyce
Dolcourt, and Helen Post.
Baby Watch Staff: Janice Boswell, (equip.), Patrice Isabella,
Vanya Mabey, Kimberly Morris, and Ellen Parrish (minutes).
I. WELCOME/INTRODUCTIONS. The meeting commenced at 9:40
AM, conducted by GleeAnn Clayton. Introductions were made.
II. APPROVAL OF MINUTES. A MOTION made by Kris Fawson
and seconded by Gina Pola-Money to accept the Minutes of May 16, 2003
as written passed unanimously.
III. LEADERSHIP TEAM REPORT
- Outgoing Members. The tri-chair presented Trisha Beck, longtime
Legislative Representative to the ICC with a plaque and thanked her
for her service. Trisha spoke briefly, thanking the Council for the
opportunity to share in working on issues that affect children with
disabilities. GleeAnn expressed the ICC’s appreciation for the
service of the following outgoing members: Jill Adams, Brenda Broadbent,
Pamela Colson and Shelley Wiseman. All of these individuals contributed
greatly to the ICC’s efforts.
- New Members. The ICC welcomes Cheryl Alexander, a Consumer
Service Examiner, as the new Department of Insurance representative.
We also welcome Connie Nink, new Section 619 preschool representative.
Three new provider representatives are joining the ICC. Dr. Mark Valentine
is a pediatrician in private practice at the IHC Sandy Health Center
and LDS Hospital. Dr. Nancy Murphy has been a clinical assistant professor
in the Department of Pediatrics at the University of Utah for two years.
Debbie Justice has been Director of the St. George Early Intervention
program, The Learning Center for Families, since 1993. And lastly, we
have a new Legislative Representative. Calvin Bird, from Springville,
sits on the Health and Human Services Appropriations Subcommittee, and
the House Health and Human Services and Transportation Committees.
- Finance Subcommittee. Barbara Fiechtl remarked that this group
did a great deal of work on the implementation of parent fees and looking
at funding issues last year. We don’t want the momentum of the
committee to drop off and therefore it will reconvene soon. All ICC
members are encouraged to participate and to watch for the meeting announcement.
- Fiscal Year 2004 ICC Themes. The Council viewed a handout
of ICC goals proposed by the leadership team, including looking closely
at funding needs, increasing interagency collaboration, the Medical
Home, and strengthening families.
Fan Tait explained the Medical Home’s approach to care, which
is a partnership with families. Care should be family-centered, culturally
competent, and collaborative. This is important because there is not
as much collaboration among early intervention and primary care providers
as we would like. We will decide how we can best approach the Medical
Home initiative—as a separate committee or as a group at regular
ICC meetings.
IV. BABY WATCH REPORT
- Parent fees background. Susan Ord thanked the ICC for its
involvement in making the decisions that led up to the implementation
of the Parent Fee system now in place, and reported on how Parent Fee
Policy is working. The Legislature did increase our funding by one million
dollars in the last session after a huge effort by providers, parents,
and other advocates. Along with the increase they required that Baby
Watch institute a system of parent fees. Before the institution of fees,
Baby Watch held public hearings across the state, a task required by
federal regulations governing procedure when changes are made to the
state plan. The Parent Fees Subcommittee met five times to work on setting
a sliding fee scale and establishing conditions governing fees. They
then made recommendations on fees to the ICC. Because of the procedural
changes involved, State Rules were written and filed. They went into
effect August 1st.
Fees range from $10 to $100 with some exemptions such as children in
foster care or on Medicaid. In order to facilitate implementation, the
state designed policies and procedures as soon as possible and submitted
the plan to the Office of Special Education Programs (OSEP) who approved
the changes. Baby Watch made a Policies and Procedure Manual for the
providers and designed a Fee Determination Form in both English and
Spanish. We tried to make it user friendly, and provided lots of instructions.
Every family in the state is required to complete this form to determine
what their monthly fee will be. Programs verify income at the request
of ICC. If families decline to disclose their income they are billed
the maximum: $100 per month. Back in 1997 the legislature also required
that Baby Watch charge fees, but this time we are much more standardized.
Fee collections take place at the state, not the local level. The Department’s
finance office hired a staff person to handle collections and bill families
monthly.
So far, about 1900 forms have been entered, but at any one time we have
about 3000 children in our program. Roughly 60% of families have completed
the forms and about 70% of those families are in the exempt category.
This number may change as additional forms are collected. Parents will
be billed for August services. Estimating the fee data so far, Baby
Watch should collect over $18,000 per month, $223,800 per year if we
collect on every bill sent out. We do not charge by services provided,
but as a monthly participation fee. There will be months when families
won’t receive any billable services and will not be charged.
Mark Valentine said it costs his office $9 to send out a bill. Applying
this figure to the Baby Watch program it would come to $324,000 per
year for 3000 families. If we are only collecting $223,800 the system
will not be cost-effective. Kris Fawson noted that historically, in
1997, after two years of fees collection, costs still outpaced earnings.
It remains to be seen what this fee system’s cost/revenues will
be.
- No-Cost Services. Federal law requires that we provide assessment,
service coordination, and the development of an IFSP at no cost. Families
have a right to these services. If they decline to receive billable
services such as occupational therapy, they can remain in the program
under service coordination only. When a child is under an IFSP they
receive a free evaluation, then we follow them and re-assesses their
progress after one year.
Judi Nielsen noted that the Utah School for the Deaf and Blind’s
Parent Infant Program (PIP) cannot charge fees. They are under legislative
mandate to provide free and appropriate sensory services from birth.
It is important that, while PIP staff is portrayed as Early Intervention
staff, families understand that PIP services are provided at no cost.
- Data Collection on Fees. Baby Watch has developed two different
forms to gather information on fee implementation. The first tracks
expenses at both the state and local levels pertaining to fees. There
is a start up cost in implementing the fees, but over continued implementation,
costs will level out. The second form captures information on families
who are declining services because of fees and the reasons for their
decision. We are gathering this information through December to provide
the Legislature with a clear view of the processes and results. Issues
to consider are:
· The impact of fees on enrollment in early intervention programs
· The effect of the procedures and the current fee schedule
· The number of families opting for a “no-cost” IFSP
· Families seeking services from private providers, or
· working with their children on their own
Barb noted that two more issues are 1.) that maybe the families who
dropped out were receiving fewer services for their monthly fee than
those who have stayed with their programs; and 2.) the effect of the
change in the eligibility definition on the numbers of children.
- Provider-to-Parent Education Process. Providers are supportive
of the fees and doing a great job of explaining program changes to parents.
Chris Giacovelli remarked that the provider attitude is that they are
skilled professionals whose services need to be valued. If someone is
paying for the services they receive they respect our services. Lynette
Rasmussen remarked that it is curious that people who provide services
to children are undervalued. As of today, out of 400 families at Jordan,
12 have dropped out because of fees. The next step to deal with will
be families refusing to pay.
Gina offered the parent perspective—that while families do need
to be responsible we must ensure each situation is considered individually.
Even though on paper it may look as if a family can afford a fee, that
may not be the case. Chris replied that this is the reason consideration
of Extenuating Circumstances was built into the Fee system.
Susan reiterated how much she appreciates the work of the ICC, its subcommittees,
and providers for their part in the fee process. Susan asked the ICC
to continue to provide input and recommendations on these matters.
V. INFANT TODDLER MENTAL HEALTH COMMITTEE ACCOMPLISHMENTS
- Background. Kristina Hindert summarized how the Expanding
Options for Infant Mental Health Committee has been in existence for
about three years to address the gap in services for this age group.
Janet Wade of Baby Watch has overseen meetings of many different people,
videoconferencing all over the state to ensure that the rural perspective
is included. The committee has been working on creating a State Practice
Model. Now the focus is on implementation of the Model and how to bring
it into communities. Contact Janet Wade if you would like to join the
committee.
- Levels of Care. The committee originally identified three levels
for the State Practice Model: Promotion, Prevention, and Intervention.
After receiving input from families that the concept of “Prevention”
was stigmatizing, the term was changed to “Proactive Intervention.”
The group has developed strategies to support each level of care such
as public awareness issues, screening for postpartum depression at well
child checkups, promoting what normal social/emotional development is,
and providing screeners online that families can access to see if their
child is developing appropriately. Getting it on the Medical Home Website
is an important step in the process. There are lots of options now that
the outline is in place. The big issue is funding. Interagency collaboration
is a part of this. Networking and education shared between agencies
doesn’t have to cost everyone money.
- Other Accomplishments. The committee created a resource guide
on the Baby Watch website listing all the mental health providers in
Utah who treat infants and toddlers. They have also developed several
infant mental health trainings including a course at the University
of Utah’s Graduate School of Social Work.
The committee’s work resulted in the establishment of the Utah
Association for Infant Mental Health (UAIMH), an affiliate of the World
Association for Infant Mental Health (WAIMH). This indicates that a
growing number of professionals are interested in this age group. WAIMH
has invited Utah to present on this model in Australia at the World
conference next year.
Janet recently attended a seminar on infant mental health at Georgetown
University in Washington DC, where she received an in-depth consultation
on Utah’s model. The values of the Medical Home system of care
reflect the values of the State Practice Model and the committee wants
to put it on the Medical Home website as a resource for physicians around
the state.
The group is participating in the Critical Issues Conference November
7 – 8, talking about the State Practice Model. We will also be
having a meeting around that time. Public awareness of the issue is
ensuring that many people getting involved. We want to connect people
at the website to be a resource, to share who is using what screening
instrument, who may be available for a quick consultation. These are
free things, that by supporting each other we might be able to provide.
Bureau of Health Care Financing Director Julie Olson’s recent
grant submission is focused on increasing awareness among primary care
providers of infant mental health issues and helping them with screening,
assessments, and referrals. A lot of different things are coming together
with a lot of momentum.
George Delavan asked about the group’s game plan for implementation.
Kristina explained that they would like to bring the three subcommittees
back together as a group to work on getting communities to pick some
goals for themselves and decide how they want to work to implement and
adopt the State Practice Model. Possibly the St. George Early Intervention
program and the Division of Mental Health will sign interagency agreements.
The committee would like to continue its work on behalf of the ICC.
VI. FAMILIES UNITED NETWORK (FUN) REPORT
- Parent Mentor Training. GleeAnn reported that the Parent Subcommittee,
now called FUN, has received a grant from the Interagency Outreach Training
Initiative (IOTI) to put together an Early Intervention Parent Mentor
Training. This will teach Early Intervention parents how to be mentors
to other parents in their communities. After the training, parents can
come back to FUN empowered to represent their community and prepared
to advise and assist the ICC. The training will be in the spring. About
two parents per program will be invited.
- FUN meeting structure. At present there are about ten active
parents but FUN wants 30 or 40 parents participating at a given time.
The committee presents parent-friendly information on issues of interest
to parents of children with special needs and sends out meeting minutes
in a newsletter form. Recently a dietician presented on feeding issues,
previously a pediatrician presented on CMV, and next time families will
learn about the transition from early intervention to preschool process.
Fan thanked the parents who came to the Department’s budget hearing.
It was an open meeting and several of our parents testified. Early Intervention
always has good parents and providers to testify which speaks to the
need for the program. Baby Watch will be requesting another million
dollars from the legislature this year and that will be included in
the Health Department’s budget that goes to the governor. He’ll
decide if it is in his budget and then that goes to the legislature.
The Department will meet with the governor’s fiscal analyst soon.
GleeAnn noted that the parents are not bound to the governor’s
budget request as the Health Department is. They can ask the legislature
for whatever funding they feel is needed. The Legislative Coalition
for People With Disabilities (LCPD) will meet with the governor’s
fiscal analyst very soon as well on these matters.
VII. MISCELLANEOUS ITEMS. Lynette Rasmussen, Director
of Child Care, DWS, announced the creation of a Child Care Professional
Development Institute. They are excited about the possibilities this will
offer. One is the exploration of a community based childcare training
that will be accepted on the career ladder.
VIII. NEXT SCHEDULED ICC MEETING. November 21, 2003
at 9:30 AM at DOH Children with Special Health Care Needs, 44 North Medical
Drive, Salt Lake City, Utah.
IX. ADJOURNMENT. The meeting was adjourned at 11:30
AM.
APPROVED AS TO FORM:
____________________________________
GleeAnn Clayton, Chair for ICC
MINUTES SUBMITTED BY:
_____________________________________________
Ellen Parrish, Executive Secretary for ICC
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