Thursday, June 21, 2012

Early Intervention Contract Language

Many early intervention services are contracted for, so the contract should be a place for the contracting agency to outline expectations about how services should be provided under that contract. Yet most agencies do not take this opportunity and then feel besieged by problems with using contract services. The biggest gripe about contracted services is the lack of control over quality. I therefore encourage agencies to include practice requirements in their contracts. Here are some suggestions.

You really should push to end clinic-based services under the IFSP, but, because some states have not achieved that goal yet, the location clause could be dropped while maintaining the rest. I encourage agencies to include practice requirements, even when they think they have no choice but to contract with the only provider in their region. Just remember that the longer you let the seller dictate the market, the harder it will be to implement recommended practices. Many states have effectively stopped clinic-based services under Part C. They had to bite the bullet and pay only for services in natural environments. Whether you keep or discard the location clause, please make use of this language.


Practice Requirements

A requirement for fulfilling this contract is that practitioners will follow evidence-based family-centered practices, as outlined in the Agreed-Upon Mission and Key Principles for Providing Early Intervention Services in Natural Environments (Workgroup…; http://www.nectac.org/topics/families/families.asp) and as described by the practitioners’ professional organizations for pediatric practices for this age group. These practices are described here in terms of location, approach, teamwork, and compliance with the law.

Location

1.       Under this contract, practitioners will provide services in the natural environments, which are described in the law and regulations as the places where the child would be if he or she did not have a disability. These places are most commonly the family’s home or the child’s child care program.

Approach

Consultation With/Coaching Caregivers

2.       Practitioners will focus their work on using a consultative approach, also known as coaching, with the child’s caregivers to enhance those caregivers’ ability to provide interventions to the child between therapy sessions. This focus means practitioners
2.1.    Spend the whole session communicating with caregivers;
2.2.    Use collaborative not expert approaches in finding solutions (i.e., deciding on interventions); and
2.3.    Demonstrate strategies as necessary.

Focus on Functioning in Routines

3.       Practitioners will address outcomes on the individualized family service plan (IFSP), which will have target skills aimed at promoting functioning in routines. This means practitioners will promote
3.1.    Child engagement, including meaningful participation, in home, school, and community activities;
3.2.    Child independence, at the level the family wants, in routines; and
3.3.    Child social relationships, including communication and social-emotional skills, in routines.

Teamwork

4.       Practitioners will support the primary service provider (PSP) by
4.1.    Making joint home visits with the PSP (if the practitioner does not practice in natural environments—see Location above, welcoming the PSP on a visit to the clinic with the family);
4.2.    Expressing to the family confidence in the PSP’s ability to support them in carrying out the practitioner’s suggestions; and
4.3.    Providing information to the PSP.

Compliance With IDEA

5.       Practitioners will adhere to Part C of the Individuals with Disabilities Education Improvement Act, because this is the law under which early intervention services are funded. Even if a third party is paying for the practitioner’s service, if the practitioner is serving the child as part of early intervention (i.e., because the agency or practitioner is listed as a Part C service on the individual child’s IFSP), legally they must follow IDEA. The law stipulates that
5.1.    The IFSP team (not a doctor or another individual person) decides on what services are to be provided and at what frequency and intensity (i.e., prescriptions or practitioners’ recommendations on these matters do not dictate services);
5.2.    Services are provided to meet the needs identified in the IFSP outcomes (i.e., not based only on diagnosis or evaluation results for eligibility); and
5.3.    Changes in services, frequency, or intensity must be coordinated with the service coordinator and decided upon by the IFSP team (i.e., individual practitioners should not tell families how often they should see the child; they should discuss a potential change with the service coordinator first).

Failure to follow any one of these five practice guidelines can result in immediate termination of the contract. Practitioners can obtain more information from the contracting agency about this current approach to early intervention service delivery. 

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