Family & Community Special Communities
Special Education

OSEP’s Report on the Monitoring of Massachusetts

III. Part C: Early Intervention Services in Natural Environments

In creating the Part C legislation, Congress recognized the urgent need to ensure that all infants and toddlers with disabilities and their families receive early intervention services according to their individual needs. Three of the principles on which Part C was enacted are:

1. enhancing the child's developmental potential;
2. enhancing the capacity of families to meet the needs of their infant or toddler with disabilities; and
3. improving and expanding existing early intervention services being provided to children with disabilities and their families.

To assist families in this process, Congress also requires that each family be provided with a service coordinator, to act as a single point of contact for the family. The service coordinator ensures the rights of children and families are provided, arranges for assessments and IFSP meetings, and facilitates the provision of needed services. The service coordinator coordinates required early intervention services, as well as medical and other services the child and the child's family may need. With a single point of contact, families are relieved of the burden of searching for essential services, negotiating with multiple agencies and trying to coordinate their own service needs.

Part C requires the development and implementation of an IFSP for each eligible child. The evaluation, assessment, and IFSP process is designed to ensure that appropriate evaluation and assessments of the unique needs of the child and of the family, related to enhancing the development of their child, are conducted in a timely manner. Parents are active members of the IFSP multidisciplinary team. The team must take into consideration all the information gleaned from the evaluation and child and family assessments in determining the appropriate services needed to meet the needs.

The IFSP must also include a statement of the natural environments in which early intervention services will be provided for the child. Children with disabilities should receive services in community settings and places where normally-developing children and their families would be found, so that they will not be denied opportunities that all children have - to be included in all aspects of our society. Since 1991, IDEA has required that infants and toddlers with disabilities receive early intervention services in natural environments. This requirement was further reinforced by the addition of a new requirement in 1997 that early intervention can occur in a setting other than a natural environment only when early intervention cannot be achieved satisfactorily for the infant or toddler in the natural environment. In the event that early intervention cannot be achieved satisfactorily in a natural environment, the IFSP must include a justification of the extent, if any, to which the services will not be provided in a natural environment.

Validation Planning and Data Collection

The Self-Study identified several accomplishments and concerns regarding the provision of early intervention services in natural environments. Accomplishments identified included: provision of services in natural settings, such as family child care and homeless shelters; serving children who are at risk for developmental delay; and provision of services to over four percent of the population of children birth to three. Concerns identified included:

1. difficulty accessing services and other resources in rural areas;
2. a lack of family participation in needs assessment and identification of services and supports;
3. the availability of personnel to meet individual needs of children in natural environments; and
4. inconsistent monitoring of IFSPs, including arranging the periodic reviews and annual reviews, by service coordinators.

At each of the public meetings that OSEP attended during the Validation Planning visit, the following question was asked: "Do all infants and toddlers and their families receive early intervention services in natural environments?" Responses indicated concern that:

1. evaluation and assessment information is not consistently linked to service planning;
2. training in IFSP development on methods of individualizing services, service location and outcome measures is inadequate; and
3. present funding methodology supports segregated infant and toddler center-based groups.

Parents and service providers indicated that services are provided in a variety of settings such as the home, childcare and in early intervention center center-based groups. A program administrator stated that "best practice" in Massachusetts has always been home-based services. Parents stated that their children take a bus provided by the DPH to attend center-based groups at the early intervention center. The parents further stated that they do not always attend these center-based groups and when they do attend they join a parent support group. Several providers stated that when suggestions for services in community settings are made, parents choose to come to the center to have "specialized providers." Providers also stated that they are trying to expand options for families that include childcare settings for those parents who are working.

At the end of the Validation Planning process, the following issues were identified as areas that could be investigated during the data collection week:

1. evaluation, assessment and service planning;
2. family participation in the IFSP process; and
3. services provided based on individualized needs.

OSEP reviewed and analyzed the data and identified the following strength, area of non- compliance, and suggestions for improved results for infants, toddlers and their families.

A. Strength

Supervisory Leadership
DPH is to be commended on its recent actions and efforts of leadership to affect system change so that all early intervention services are provided to infants and toddlers with disabilities and their families in natural environments throughout the State. Consistent with its general supervision responsibilities, the State determined that there was a problem with local practices around individualizing services and providing services in community settings that included young children without disabilities, in some areas of the State. DPH instituted several strategies for improvement including: direct negotiation onsite with providers and families; the provision of training opportunities; and the withholding of program funds. To ensure system change, the State has recently issued a Request for Proposals for six regional consultant teams to train other providers to work with infants and toddlers with multiple needs and their families. The grants include funds specific to parent training and support activities and training for child care providers to improve opportunities for quality care for families with infants with disabilities.

B. Area of Noncompliance

34 CFR §303.344(d) requires that the IFSP must include a statement of specific early intervention services necessary to meet the unique needs of the child and the child's family to achieve the outcomes identified, including the frequency, intensity, and method of delivering services, the location in which early intervention services will be provided, and a justification of the extent, if any, to which services will not be in natural environments. These decisions must be based on the results of evaluation and assessment and are made by the IFSP team, on an individual basis, to meet the child and family's unique needs.

Lack of Justification for Provision of Some Early Intervention Services in Settings Other than Natural Environments

OSEP found that DPH provides most early intervention services in natural environments. However, the majority of IFSPs that OSEP reviewed across all sites contained some services in a center-based setting; parents, service providers and administrators stated that the center-based groups typically do not include children without disabilities. Such settings do not constitute natural environments for the child under the definition in §303.18. Although a State may provide services in such settings if a justification, based on the individual child's needs, is included in the child's IFSP, §303.167(c), 303.344(d)(1)(ii), in every IFSP that OSEP reviewed in Massachusetts, there was no written justification.

In one site, two records indicated a discussion of center-based groups which focused solely on the age of the child rather than on the identified developmental needs of the child. OSEP found that two of six IFSPs reviewed in a second site indicated center-based group services with no justification statement. In a third site, one IFSP indicated the child received home visits by an educator but had to attend the center-based group to receive occupational and speech therapy services.

Administrators and providers told OSEP that parents choose center-based services for their children because parent support groups are available simultaneously. Parents in all sites visited reported that they participate in parent support groups exclusively at the early intervention centers "to meet other parents". When OSEP asked parents whether other options for parent services were presented to them, parents reported that there is no discussion in IFSP meetings of parent services such as support groups in any context other than the center-based services.

34 CFR §303.322(d) requires that information concerning the resources, priorities, and concerns of the family related to enhancing the development of the child and the identification of the supports and services necessary to enhance the family's capacity to meet the developmental needs of the child, are designed to be included in discussions at intake and during the evaluation and assessment. The IFSP team, which includes the parent, identifies parent support, training or counseling, as a needed early intervention service, that can be provided through Part C, or by referral to an organization that offers these particular services (e.g., a Parent Training and Information Center, a Parent -to Parent program, other family support or advocacy organizations within their communities). A variety of locations for training activities could be considered, such as a public library, another family's home, the local toddlers swim program etc. Because a parent's need for time with other parents of children with disabilities can be successfully accommodated in the natural environments where the child receives services, or in separate meetings, this parent need can not be used as justification to deny the child the appropriate services in natural environments. (See OSEP 10/19/99 letter to Pennsylvania).

DPH must ensure that determinations of service location are made by the IFSP team based on the child's needs, and that a justification statement is included in the IFSP when the team determines that early intervention cannot be achieved satisfactorily in a natural environment for a particular service for that child.

C. Suggestions for Improved Results for Infants, Toddlers and Their Families

1. Identification of child's and family's typical routines and daily schedules to support decision- making on service location within neighborhoods and communities

Service providers, parents, service coordinators and administrators told OSEP that while many children received services at home or in other natural environments including child care settings, segregated parent/child groups and developmental toddler groups at the early intervention center were routinely offered to families and included on IFSPs. Providers explained the lack of justification on IFSPs on the fact that other services that the child needed were delivered in community settings that included children without disabilities. OSEP recommends that DPH provide a focused training on the methods of linking identified needs and services to each child's specific developmental outcomes within the context of typical family and community life.

2. Training activities to support and build upon service delivery models that use family and community life as sources of learning opportunities for infants and toddlers with developmental disabilities and their families.

Given the training needs identified by the Steering Committee during validation planning, OSEP recommends that DPH, as part of its comprehensive system of personnel development, consider the development of joint training opportunities for parents and service providers in service provision in community settings, and natural environment requirements, challenges, and barriers. In addition, DPH should identify the historical programmatic issues and funding concerns that affect the kinds of practices associated with the child, the parent and the family.