FFY 2015 - Annual State Grant Application
Final Child & Family Connections (CFC) Procedure Manual as of April 20, 2015
Chapter 16: Forms, Sample Letters and Reference Materials - No Changes
CFC Procedure Manual - Individualized Family Service Plan (IFSP) Form Instructions & Non-Cornerstone Service Plan Pages
PURPOSE OF THE STATEWIDE INDIVIDUALIZED FAMILY SERVICE PLAN
The IFSP statewide format is intended to facilitate the collection of essential information under the requirements of the Individuals with Disabilities Education Act (IDEA), specifically Part C. This form must be used to adhere to regulations for recordkeeping of the relevant state agencies participating in the Early Intervention Services System in conjunction with the lead agency. The Illinois IFSP, made up of reports generated by the state's electronic data management system, hardcopy forms completed by and/or with the family, and other attachments as necessary, serves as a common form which may be used by different public and private agencies that provide early childhood services to children and families.
GENERAL DOCUMENT GUIDELINES
The IFSP is an important document. Those portions of the IFSP that are required to be completed by hand must be completed in ink.
Record the child's name, EI# and Cornerstone ID# on the top of each of the hardcopy IFSP pages. Each page of the IFSP must be dated, reflecting the date of the IFSP development meeting, even if some of the information is collected and confirmed prior to this meeting date. When updated (based on review), the date on the top of the updated pages should reflect the review date. Updated pages must be filed within or attached to the child's current IFSP document, the Cover Page of which will direct auditors to the IFSP begin and end dates.
IFSP information must be routinely and regularly verified for accuracy.
The original, signed IFSP is maintained in the child's comprehensive early intervention record and housed at the local Child & Family Connections.
The IFSP process begins at referral and the initial intake, and occurs over a series of meetings among parents and service providers, throughout the provision of services until the child no longer receives services.
The IFSP is a confidential document. Photocopies of the completed IFSP may be distributed as directed by the parents' informed, signed consent.
A copy of the completed IFSP must be provided to the parents of a child found eligible for Part C Early Intervention services as soon as reasonably possible following completion.
The IFSP cannot be implemented without the signature of the parent/surrogate parent in Section 7: IFSP Implementation and Distribution Authorization.
All necessary services for each eligible child as agreed upon by the team members, including the family, must be documented on the IFSP regardless of availability or fund source.
The Cover Page provides identifying information concerning the child and family, names key individuals in the child and family's lives, and indicates the child and family's Early Intervention Service Coordinator.
34 CFR Part 303, Section 303.344 (g) Identification of Service Coordinator.
SERVICE COORDINATION RESPONSIBILITIES:
The IFSP Cover Page is a template on the Cornerstone system called a participant form. The child's demographic information and the CFC/Service Coordinator information, located at the top of the Cover Page, are pulled from a variety of data sources in the Cornerstone system, including the enrollment screen, the address screen, the clinic administrative data table and the employee information screen. It is important that the information entered into the Cornerstone system be as accurate as possible. Inaccurate data entry will result in inaccurate data output on the IFSP Cover Page.
The Provider Information and Other Helpful Resources section may be completed prior to the IFSP meeting if the information being entered is known (i.e. LIC Coordinator information, etc.). During the IFSP meeting the IFSP team should review the completed information and identify and document other "helpful resources", including the Primary Care Physician (PCP), on the IFSP Cover Page (Participant Form EICV). The PCP should always be identified on the Cover Page of the IFSP and the service coordinator should discuss with the family the importance of sharing information with the PCP, including the status of the referral and the IFSP document.
COMPLETION INSTRUCTIONS:
Locate the IFSP Cover Page participant form (CM10 - EICV). If you have difficulty locating this form please refer to the Cornerstone User Manual.
Complete the required information (Name, Address, Phone and Fax/E-mail) for all predefined roles (Primary Care Physician, Parent Liaison, LIC Coordinator, School District/LEA Representative, and DCFS Caseworker, if applicable). Based on discussions with the family, use this space to capture information regarding individuals who play key roles in the lives of the child and/or family.
When the IFSP document is ready to be distributed, use the checklist at the bottom of the Cover Page to make sure that all components are included.
UPDATING INSTRUCTIONS:
When to update:
As needed when a change of information occurs.
Reviewed for accuracy at each review.
Updated as needed at each annual re-evaluation/review.
How to update:As mentioned earlier, the demographic information on the electronic Cover Page is pulled from a variety of data fields in the Cornerstone system. If the demographic information is inaccurate or needs to be updated, users must return to the data field of origin. For example, the child's address, phone number and primary contact are derived from the child's address information as entered on PA03-F9. If this information changes, or is inaccurate as printed on the comprehensive IFSP report, users must return to the child's address field on PA03-F9 and update or correct information, as necessary.
Who updates:Service Coordinator
Updating Procedures: Attach the updated Cover Page to the top of the IFSP document. Do not discard the original Cover Page. Updated pages must be attached to or filed within the child's current IFSP document. Once the IFSP has been updated print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy.
FUNCTIONING LEVELS OF DEVELOPMENT
The Levels of Development section of the IFSP is a place to all synthesize all evaluation and assessment information, including family reports and observation data that have been collected and reviewed during the intake interview(s), eligibility determination and other IFSP evaluation activities. The Levels of Development section of the IFSP is also used to document the child's functional status compared to his/her same age peers at the time of the initial IFSP, as well as progress at each annual IFSP and prior to exit at age three. The information in the Levels of Development section of the IFSP should provide meaningful information to the family regarding their child's development so that they will be better able to participate in the IFSP development process and to meet the needs of their child and their family independent of the EI Services System.
34 CFR Part 303, Section 303.344 (a) information about the child's status, and Section 303.322 (b) Definitions of Evaluation and Assessment, (c) Evaluation and Assessment of the child and Section 303.323 Nondiscriminatory Procedures.
Provide all team members with a description of what is needed to complete questions 1 through 10 on the AS03 - EI Levels of Development. Assist members as needed in organizing this information. Ensure that all needed information is gathered prior to the child and family's IFSP meeting. Complete the EI Levels of Development portion of the IFSP at the IFSP meeting with the family and the other members of the IFSP team. Ensure that all members of the team have a clear picture of the child's developmental status in each developmental domain and are able to form opinions and make recommendations based on shared information.
The child's present levels of development are captured on the AS03 screen in Cornerstone.
Variable amounts of information may be entered prior to the IFSP meeting based on input from the parent(s) during the Intake and available evaluation/assessment information available.
AS03 - EI Levels of Development/Child Outcome Ratings
Locate the AS03 assessment. If you have difficulty locating this assessment please refer to the Cornerstone User Manual.
Questions 1 and 2 may be completed prior to the IFSP meeting using information gathered from the family during Intake and medical and/or other records obtained and reviewed prior to the IFSP meeting.
Question # 1: Describe the child and family's strengths and challenges and the family's priorities, resources and concerns.
Question #2: Summarize the child's health status, including his/her hearing and vision status.
Questions #3 - #7: Enter the child's percent of delay and/or age equivalent in months as reported or verified by the child's evaluator. Also, describe the child's current level of functioning in each developmental domain. This description should convey to the family and other IFSP team members meaningful information about the area of development. For example, "Johnny can stack 2 blocks" is probably not meaningful to a parent. Whereas, "Johnny's fine motor skills, which he will need to button his shirt, tie his shoes, and use pencils, crayons and scissors, are mildly delayed" is meaningful.
Questions #8 - #10: Discuss the child's current functional status with the IFSP team. Do not focus on the child's discrete developmental domains (i.e. communication, motor, cognitive). Rather, use the three Child Outcomes to focus the discussion on the child's functioning during everyday routines and activities. The following decision tree may be used to assist the team in reaching consensus regarding the child's present level of functioning related to each of the three Child Outcomes.
At the end of the AS03 assessment document the Sources of Information used to gather developmental, social, family and health/medical information about the child. Multiple sources of information will likely be used in order to obtain comprehensive information. Sources of Information may include:
Formal Assessment Instrument
Formal Parent Interview/Rating
Informal Parent Interview
Existing Med/Dev Records
Clinical Opinion/Judgment
If one or more sources is a formal assessment instrument, select the assessment instrument used in the second column. Finally, document the date on which the assessment was completed or the source of information was completed/obtained/reviewed.
3. Make sure that the child's primary diagnosis, including a narrative description of the ICD-9 code, has been captured on the SV01 screen.
Check for appropriateness at each review.
Rewrite at the annual re-evaluation/review.
Ensure all information is current and conduct a final Child Outcome measurement rating no more than 120 days prior to exit at age 3.
AS03 - Questions may be updated at any time.
Who updates:
The IFSP team provides updated information in preparation for an IFSP meeting. The service coordinator enters the information into the Cornerstone system.
Updating Procedures:
When updated (based on review), the date on the top of the updated pages should reflect the review date. Do not discard the original developmental information. Updated pages must be filed within the child's current IFSP document. The Cover Page will direct auditors to the IFSP begin and end dates. Once the IFSP has been updated print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy. Updated pages must be copied and distributed to those individuals for whom the parent(s) provided written consent to receive the IFSP.
IFSP FUNCTIONAL OUTCOMES
The outcome section provides the format for defining individual outcomes related to the child and family's needs. It provides space to identify strategies and/or activities designed to facilitate the achievement of the individual outcomes and services and/or supports that are available to assist the family with those strategies and/or activities. The outcome section also provides an opportunity to discuss natural environments.
34 CFR Part 303, Section 303.344 Outcomes, Section (d) Early Intervention Services, (e) Other Services, Section 303.342 (b), Periodic Review and Annual Meeting to Evaluate the IFSP and Section 303.12 General Role of Service Providers.
The service coordinator should review this section with the family during the IFSP planning period. The family should be assisted in developing some outcome statements for presentation and discussion at the IFSP team meeting. These outcomes, developed by and/or with the family, should form the basis of discussion and together with other IFSP team member input should contribute to the design of an array of strategies, activities and services that are appropriate for the child and family.
More than likely the activities performed by service coordinators will be reflected within one or more of the outcomes developed by the IFSP team. This is a wonderful opportunity for families to learn more about the role and functions of the service coordinator. As families begin to understand this role, they can begin to assume aspects of this role themselves over time well before their transition from early intervention.
Outcomes are changes that the family wants to see occur for their child or their family. Within the outcome section we indicate what should happen (strategies and/or activities) to assist the family in meeting the needs of their child due to his/her developmental concern and what services and/or supports are needed to assist the family with these strategies and/or activities.
Outcomes should be simply written and reflect what the family is most interested in achieving over a given period of time (for example, six months or one year). Strategies and activities represent those specific interventions that are designed to promote the changes that the IFSP team wants to see occur for the child and family.
Develop one outcome per page. There may be as many pages for major outcomes as needed with each subsequent page being numbered at the bottom of the page 1 of 1, 1 of 2, 1 of 3, etc.
Outcomes may have several strategies, activities and services designed to accomplish the outcome.
What do we want for ___________________ and our family?
Enter the child's first name (or nickname) in the space provided.
Record the description of the outcome that family members want to see for their child or themselves, in any area of child development or family life related to the child's development. While it is the role of the IFSP team to assist the family in identifying outcomes that are realistic and achievable, the determination of a family's resources, priorities and concerns is ultimately the role of the parent.
State the outcomes in functional terms, including what is to occur (process) and what is expected as a result of these actions (product) (e.g. "We want Johnny to talk more so that he can communicate his needs to us better", or "We want to find a safe and competent day care provider so that Johnny's development will be stimulated while I'm at work"). An outcome may be a family or a child outcome.
How will we achieve this outcome?
Present the family with options and choices that represent a variety of strategies and activities that would meet the identified outcome.
Strategies may include family training/education activities necessary to achieve a developmental outcome for the child or strategies related to therapeutic interventions conducted specifically with the child. Another example of a strategy could be providing resource materials to the family to assist in their participation in activities addressing the outcome, or modifications to the environment, positioning or materials and or equipment (such as a feeding chair) that would assist in the activities related to the outcome.
The strategies and activities documented here should reflect broader strategies and/or activities to be carried out or facilitated by specific individuals identified in the IFSP. Treatment plans specific to individual disciplines should be shared with the family and may be attached to the IFSP but should not be copied onto the outcome section.
Document the steps to be taken to link the family with or secure funding for the needed services and/or supports that may facilitate the achievement of the identified outcome(s) which are not required to be provided by the EI Services System (i.e. child care, state health insurance coverage, etc.).
What EI and/or other services and supports would help us with this?
Identify those services and supports that will be accessed or investigated to assist with the achievement of this outcome.
Both EI services and other services needed by the child and/or family that are not required to be funded under EI, should be reflected in this column. In relation to Johnny's outcome listed above, an example of a service which would assist with the achievement of the outcome may be developmental therapy or, if appropriate, speech therapy. An example of a support would be a local parent group that provides a nursery service during the group meeting time. This would provide mom with support (if identified as a need) and would offer Johnny an opportunity for socialization and communication with typically developing peers.
Indicate the fund source (i.e. DSCC, private insurance) responsible for payment or from which payment is being sought for services not provided through EI. All covered EI services must be authorized. Therefore, it is not necessary to identify "EI" or "CBO" in the fund source column.
Upon review, how are we doing?
As the plan is reviewed, document progress made during the weeks/months of the plan's implementation. The assessment of this progress should be made through formal and informal assessment activities, including parent report and IFSP team member input.
Document changes to the outcome or any strategies, activities, services, or supports in the space provided. NOTE: Any change to the frequency, intensity, duration or location of service must be supported by written justification for the change based on formal and/or informal assessment activities, including parent report, and must be agreed upon by the IFSP team via a team meeting.
Obtain written, parental consent to change the frequency, intensity, duration or location of any EI service.
Provide the family with written notice of changes to individual service providers within a reasonable amount of time prior to the provider change.
Natural Environments
Based on the information obtained through informal discussions with the family and formal family assessments the IFSP team should be knowledgeable of the child's daily learning environments. If at the time of the IFSP meeting the IFSP team appears to be unaware of the child's daily learning environments, this discussion should occur prior to outcome development.
Review the EI services needed to achieve this outcome and discuss with the IFSP team the most appropriate location(s) for service delivery.
Indicate in the box provided whether the early intervention services identified will be provided/are being provided in natural environments. The federal law defines natural environments as "settings that are natural or normal for the child's age peers who have no disabilities," [CFR 303.12(4)(b)(2)], and requires that services be provided in natural environments unless intervention cannot be satisfactorily achieved there.
If it is determined that a specific service must be provided in a setting other than a natural environment, complete the Natural Environments Worksheet. The Natural Environments Worksheet should contain a statement of justification that:
Describes the basis of the IFSP team's decision,
Is based on the identified needs of the child and the projected outcomes as determined by the evaluation and assessment, and
If appropriate, is based on the nature of the service required to meet the unique needs of the child.
4. If it was determined that a specific service was to be provided in a setting other than a natural environment, ensure that the Natural Environments Worksheet is maintained as a part of the IFSP document and is available for review by federal and state monitors.
At any point in time at parent or provider request based on the changing priorities, resources and concerns of the family or the developmental needs of the child.
Rewrite at each annual re-evaluation review. [NOTE: The IFSP team may choose to retain one or more outcomes from the previous year's IFSP. If reasonable to do so, the service coordinator may copy the old outcome page and include it in the new IFSP, or the IFSP team may choose to rewrite the outcome in order to provide a cleaner form to last through the new IFSP period.]
Document changes to the outcome or any strategies, activities, services or supports in the review column. Add an additional page if additional outcomes are identified upon review. File provider justifications for changes in early intervention or other services in the child's comprehensive early intervention record.
Service coordinator based on input from the family and IFSP team members.
When updated (based on review), the date on the top of the updated pages should reflect the review date. Do not discard the original outcome information. Updated pages must be filed within the child's current IFSP document. The Cover Page will direct auditors to the IFSP begin and end dates. Once the IFSP has been updated print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy. Updated pages must be copied and distributed to those individuals for whom the parent(s) provided written consent to receive the IFSP.
AUTHORIZATIONS
The SV07 screen identifies EI services, the method of service delivery, the beginning and end dates for each service, the location of service provision, the frequency and intensity of services, the name of the Payee responsible for providing the service, the name of the individual providing the service (if different from the payee) and the status of the service authorization. This screen captures the information necessary to generate an authorization for services.
34 CFR Part 303, Section 303.344(f) Duration of Services, Section 303.12 Early Intervention Services, (a) General (b) Natural Environments and (d) Types of Services and Section 303.346 Responsibility and Accountability.
All early intervention services must be justified, must be related to at least one outcome, and must be based on multidisciplinary team consensus.
If the parent does not consent to a service, it should not be authorized. (Services for which consent is not received may be documented as a need identified by the IFSP team in the outcome section and refusal to consent to the service(s) must be indicated in Section 7 by the parent.)
All necessary services for each eligible child as agreed upon by the team members, including the family, must be documented on the IFSP regardless of availability.
If changes are requested within the first three months of the plan, the original IFSP team must reconvene with the provider who is recommending the changes in attendance.
The discussion regarding service recommendations should begin during outcome development and should naturally flow into the authorized service plan. Refer to the Child and Family Connections Procedure Manual section 05.30.30 Initial/Annual IFSP Development for specific procedures related to service authorizations.
Locate the SV07 screen. If you have difficulty locating the SV07 screen please refer to the Cornerstone User Manual.
Complete a service authorization for each Early Intervention service. If you need assistance completing the SV07 screen, please refer to the Cornerstone User Manual or contact your assigned EI specialist. If you need assistance completing authorizations for Assistive Technology or Eyeglasses, please refer to sections 05.30.50 and 05.30.60 of the Child and Family Connections Procedure Manual.
At any point in time as needed at parent or provider request.
Checked for appropriateness at each review.
Rewritten at each annual review, with written parental consent.
The following fields can be edited on existing authorizations as needed:
Edit the status field in order to discontinue or cancel an authorization for services as appropriate based on the following guidelines:
Discontinue an authorization when there is any chance that services have been provided under the existing authorization. By discontinuing an authorization, the authorized provider may bill for services rendered during the authorized service period and within the authorized service parameters. Discontinuing an authorization automatically changes the authorization end date to today (the date of discontinuation).
Cancel an authorization when and only when there is no chance that services have been provided under the authorization. By canceling an authorization, the authorized provider may not bill for services rendered during the authorized service period or within the authorized service parameters.
Once an authorization has been sent to a provider, it is strongly recommended that the authorization be discontinued rather than canceled.
Updated pages must be filed within the child's current IFSP document. The Cover Page will direct auditors to the IFSP begin and end dates. Once the IFSP has been updated print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy. When distributed, the revised IFSP should be accompanied by a cover letter describing the enclosed update(s). It is very important that providers receive timely notification of any authorization changes in order to avoid confusion regarding service provision. Updates should be copied and distributed within 5 working days.
To document all required transition activities.
34 CFR Part 303, Section 303.344 (h) Transition from Early Intervention Services.
The service coordinator will inquire as to whether transition activities are needed and/or scheduled. The service coordinator and the other IFSP team members will determine the timely, appropriate steps and person or persons who will be responsible for completing transition activities. These activities may facilitate transitions within or from the Bureau of Early Intervention.
Transition planning should occur prior to any transition from Consent for Release of Information. The goal of transition planning includes the development of transition outcomes. These are the first outcomes listed and included in the IFSPs of all children; whether or not they are eligible for Part B. Transition planning should occur at least 90 days but no more than nine (9) months prior to the child's birthday. Transition planning provides for 1) discussions and training regarding future services and other matters related to the child's transition, 2) procedures to prepare the child for changes in service delivery, including steps to help the child adjust to and function in a new setting, and 3) with the family's consent, transmission of information about the child, including evaluation and assessment information and a copy of the IFSP, to the Local Education Agency (LEA) to ensure continuity of services.
Discussions regarding transition may occur at any time during the early intervention process. The service coordinator should initiate discussions in order to optimize the transition planning time. Transition planning may be used to facilitate a variety of transition experiences, including transitions to new service providers, to new service delivery options, to the home after a hospital stay, to new living arrangements or to community activities.
Transition activities are recorded in Cornerstone on the Early Childhood Tracking Screen (PA34).
Ensure that formal transition planning begins as early as nine (9) months but no later than six (6) months prior to the child's third birthday.
Complete Section I of the EI to EC Tracking Form.
If applicable, forward to the LEA/School District (See Transition Section of this manual).
Enter Section I on the Early Childhood Tracking screen (PA34) in Cornerstone.
1. Update when the EI to EC Tracking Form is returned to the CFC by the LEA/School District.
Edit the Early Childhood Tracking screen (PA34).
CFC Staff.
IFSP IMPLEMENTATION AND DISTRIBUTION AUTHORIZATION
The intent of this page is 1) to certify that the family consents to IFSP implementation and 2) to indicate who can receive copies of or view the IFSP. The IFSP cannot be implemented or distributed without this authorization.
34 CFR Part 303, Section 303.18 Parent, Section 303.342 Procedures for IFSP Development, Review and Evaluation, including (e) Parental Consent, and Section 303.404 (a)(2) the Consent to Initiate Services.
Informs the parent(s) of their rights regarding distribution of the IFSP document and the authorization to implement services. The service coordinator then assures that the IFSP is appropriately distributed and that services are implemented as directed by the IFSP.
Ensure that the family understands their rights and responsibilities with regard to the IFSP.
Document whether the family is consenting to all services identified in the IFSP.
If the family is not consenting to all services identified in the IFSP, document those services for which the family is not consenting.
Document the parent's refusal of services, if appropriate.
Identify other individuals whom the family would like to receive a copy of the IFSP.
Obtain the parent's or foster parent's signature(s) in order to implement the IFSP.
Obtain parent signature in order to document written parental consent to implement modified or new services as needed.
Obtain parent signature to implement the annual IFSP.
Should any information change or should the parent opt to refuse services during the course of the IFSP period:
Complete a new IFSP Implementation and Distribution Authorization page.
Adjust the end date on all affected service authorizations as appropriate.
Notify all affected providers of the service authorization changes immediately.
When updated (based on review), the date on the top of the updated pages should reflect the review date. Do not discard the original signature page. Updated pages must be filed within the child's current IFSP document. The Cover Page will direct auditors to the IFSP begin and end dates. Once the IFSP has been updated print, copy and distribute the document in its entirety to the family, the EI service providers listed in the IFSP and anyone else the family has consented to receive a copy within 5 working days.
IFSP MEETING PARTICIPANT/CONTRIBUTOR LIST
To document the individuals who participated in the IFSP development meeting as well as those who participated by providing input, ensuring interdisciplinary team and parent participation.
34 CFR Part 303, Section 303.17 Multidisciplinary, Section 303.18 Parent, Section 303.342 Procedures for IFSP Development, Review and Evaluation, Section 303.343 Participants in IFSP Meetings and Periodic Reviews.
SERVICE COORDINATION RESPONSIBILITIES AND PROCEDURES:
Service coordinators will complete this section at the IFSP development meeting or IFSP review meeting upon parent request. As indicated by the IFSP Table of Contents, this is an optional section. However, if completed, it must be included as part of the IFSP document.
At each IFSP review meeting.
Service coordinator.
Include with the revised IFSP for distribution as needed.
IFSP PAGES NOT ON CORNERSTONE
Section 1: Family Considerations - (Optional)
Section 3: Functional Outcomes
Section 7: Implementation and Distribution Authorization
Section 8: Meeting Participant/Contributor List
Natural Environments Worksheet