September 27, 2004

Honorable Christine C. Ferguson

Commissioner

Department of Public Health

250 Washington Street

Boston, Massachusetts 02108-4619

Dear Commissioner Ferguson:

The purpose of this letter is to respond to Massachusetts's March 31,
2004 submission of its Federal Fiscal Year (FFY) 2002 Annual Performance
Report (APR) for the Individuals with Disabilities Education Act (IDEA)
Part C funds used during the grant period July 1, 2002 through June 30,
2003. The APR reflects actual accomplishments made by the State during
the reporting period, compared to established objectives. The APR for
Part C of IDEA is designed to provide uniform reporting from States and
result in high-quality information across States.

The APR is a significant data source utilized in the Continuous
Improvement and Focused Monitoring System (CIFMS) implemented by the
Office of Special Education Programs (OSEP), within the U.S. Department
of Education. The APR falls within the third component of OSEP's
four-part accountability strategy (i.e., supporting States in assessing
their performance and compliance, and in planning, implementing, and
evaluating improvement strategies) and consolidates the self-assessing
and Improvement Planning functions of the CIFMS into one document.
OSEP's Memorandum regarding the submission of Part C APRs directed
States to address five cluster areas: General Supervision; Comprehensive
Public Awareness and Child Find System; Family Centered Services; Early
Intervention Services in Natural Environments; and Early Childhood
Transition.

# Background

In its June 21, 2000 Monitoring Report, OSEP identified one area of
noncompliance: lack of justification for the provision of some early
intervention services in settings other than natural environments (34
CFR §303.344(d)(ii)). Massachusetts submitted an Improvement Plan to
address that issue, and OSEP stated in its February 13, 2004 letter
regarding the FFY 2001 APR and the State's September 2001 Progress
Report that the State has implemented all of its improvement activities
and addressed the noncompliance regarding that issue.

In July 2003, OSEP conducted a visit to Massachusetts to verify the
effectiveness of the State's systems for general supervision and
collection of data under section 618 of the IDEA. In OSEP's October 27,
2003 letter regarding the visit, in order to ensure that DPH could meet
its responsibility to submit accurate data under 618, OSEP requested
that the State submit, within 60 days of October 27, 2003, its plan for
ensuring that settings data, services data, race/ethnicity data, and
IFSP data on assistive technology were accurate by February 1, 2004 and
November 1, 2004, when DPH was required to make its next section 618
data submission to OSEP. DPH submitted its plan on December 22, 2003 and
OSEP approved DPH's plan on April 5, 2004.

The State's APR should reflect the collection, analysis, and reporting
of relevant data, and document data-based determinations regarding
performance and compliance in each of the cluster areas as well as any
other areas identified by the State to ensure improvement. OSEP's
comments on the FFY 2002 APR are listed by cluster area.

### General Supervision

Noncompliance was not identified in OSEP's Monitoring Report of June 21,
2000 for this cluster area. As noted above, in its October 2003
verification letter, OSEP informed the State that DPH must ensure that
data submitted under section 618 for settings, services, race/ethnicity,
and assistive technology as listed on the IFSP were accurate. In the
State's February 2005 submission of its 618 report, the State must
provide confirmation that its December 2003 data plan was implemented
and that the data reported are accurate. The data in the FFY 2002 APR
indicated an area of potential noncompliance in this cluster. DPH
identified a systemic issue concerning the 45-day timeline (in
Massachusetts, a 45-day timeline from referral to signature on the IFSP
has been required) through program recertification visits, contract
performance measures, provider assistance requests for technical
assistance and service delivery data reported through the State's data
management system. Data indicated a State average of 69.5 percent
compliance with this requirement during this reporting period. DPH
reported in the FFY 2002 APR that it did not meet its 100 percent target
because of the challenge in implementing its standard with a large
population of eligible children. DPH indicated that it planned to revise
the 45-day requirement in 2004 to be consistent with Federal Part C
requirements that evaluations and assessments be conducted and an
*initial IFSP meeting* be held within 45-days after the Lead Agency
receives a referral (34 CFR §§ 303.321(e)(2), 303.322(e), and
303.342(a)). In the FFY 2003 APR (due March 31, 2005), DPH must provide
data on whether initial IFSP meetings were convened within 45 days of
referral to Part C. If the data indicate systemic noncompliance with the
Part C 45-day timeline requirement, a plan including strategies,
proposed evidence of change, targets, and timelines must be included in
the FFY 2003 APR to ensure correction of the noncompliance within a
reasonable period of time, not to exceed one year from the date when
OSEP accepts the plan.

OSEP's October 27, 2003 verification letter identified a concern that
DPH "has not yet ensured full and timely correction of noncompliance" in
some programs. In a December 22, 2003 letter, written in response to
OSEP's October 2003 letter, DPH provided further information regarding
the enhancement of its monitoring process to include "interim"
certification and compliance visits. In addition, on pages two through
four of the FFY 2002 APR, DPH provided a summary chart of the findings
of noncompliance it made during the State fiscal years (SFY) 2002 and
2003 and indicated that, in some instances, DPH conducted follow-up
visits to providers. In a recent conversation with OSEP regarding this
chart, the State clarified that within 30 days of its identification of
noncompliance with Part C requirements, a corrective plan is requested
by DPH and received from the provider. OSEP looks forward to reviewing
further data regarding the State's correction of State identified
noncompliance in the next APR.

The State reported that three complaints, one mediation request and one
due process hearing request occurred during the reporting period. On
pages 9-11, the State provided strategies that included State-wide
program monitoring, and training in dispute resolution and procedural
safeguards to ensure procedural safeguards were being implemented. In
addition, DPH reported on activities to achieve targeted results for
July 1, 2003 through June 30, 2004.

### Comprehensive Public Awareness and Child Find System

Noncompliance was not identified in OSEP's Monitoring Report of June 21,
2000 for this cluster area. On page 17 of the FFY 2002 APR, DPH reported
that the enrollment of eligible children in early intervention continued
to increase from 22,808 in 2001 to 27,891 in 2003. The State also
reported that it was collaborating with the Department of Social
Services to have a pilot program to ensure that all infants and toddlers
with substantiated allegations of abuse or neglect received a referral
to early intervention services. Data resulting from this collaboration
was tracked by both DPH's data management system and the Heller School
for Social Policy at Brandeis University. On page 18 of the FFY 2002
APR, the State listed the following factors, identified in the 2002
Massachusetts birth data report, that contributed to increased
enrollment: (1) increased number of low-birth-weight infants; (2)
decreased infant mortality; (3) increased number of older mothers, (4)
increased number of multiple births; (5) increased number of foreign
adoptions of young children; and (6) a national epidemic of young
children diagnosed on the autism spectrum. Separate from the APR, DPH
reported that the percentage of children under the age of three
determined eligible for Part C was comparable to State and national
demographic data for the percentage of infants and toddlers with
developmental delays. DPH reported that the percentage of eligible
infants with disabilities under the age of one receiving Part C services
was comparable with national and State prevalence data. In addition, the
APR data indicated that 30 percent of infants in 2003 were referred
between birth and six months of age.

### Family Centered Services

Noncompliance was not identified in OSEP's Monitoring Report of June 21,
2000 for this cluster area. The State reported in the FFY 2002 APR that
it was improving family centered services by promoting family leadership
in State and local implementation activities including parent staff
positions at the Lead Agency, parent leadership projects, and parent
participation in child identification and referral efforts. Although not
reported in the APR, OSEP is also aware that the State intended to
develop an instrument to measure outcomes and a family needs
questionnaire.

OSEP's response to DPH's FFY 2001 APR requested that the State include
monitoring data in the FFY 2002 APR regarding the number of IFSPs
reflecting family assessments offered and conducted, and other available
data to establish the effectiveness of activities related to both
performance and compliance. The State did not respond whether it
collected such monitoring data or describe the effectiveness of previous
activities related to performance and compliance. In the next APR, DPH
must submit the data and its analysis that OSEP requested, with a
determination of compliance or noncompliance.

### Early Intervention Services in Natural Environments

One area of noncompliance was identified in OSEP's June 21, 2000
Monitoring Report in this cluster: lack of justification for the
provision of some early intervention services in settings other than
natural environments (34 CFR §303.344(d)(ii)). In its February 13, 2004
letter regarding the FFY 2001 APR and the State's September 2001
Progress Report, OSEP recognized that the State had completed its
activities/strategies listed in the State's Improvement Plan that OSEP
had previously accepted, and that the State had addressed the
noncompliance regarding that issue. On pages 27 and 28 of the FFY 2002
APR, the State reported that: (1) 94.8 percent of all services were
provided in community-based settings; (2) the percentage of IFSPs
reviewed that lacked appropriate justification statements improved from
6.5 percent to 2.1 percent between 2002 and 2003; (3) data indicated
that child group services were almost exclusively provided in community
settings; (4) sampling data indicated that all services needed and
identified were listed on IFSPs and were provided; and (5) 99 percent of
enrolled children with IFSPs had an assigned service coordinator
designated in IFSPs for 2002 and 2003. The State attributed falling
short of the 100 percent target for the assignment of service
coordinators to ongoing system growth and the temporary use of an intake
team for initial intake and evaluation that resulted in the assignment
of a service coordinator after the process was completed. DPH reported
that they would continue to track the assignment of service coordinators
as a quality indicator through their data management system and program
monitoring.

The Part C FFY 2001 and 2002 APRs requested data on the percentage of
children participating in the Part C program that demonstrated improved
and sustained functional abilities (in the development areas listed in
34 CFR §303.322(c)(3)(ii)). In its FFY 2002 APR, DPH reported
baseline/trend outcome data for children with IFSPs with developmental
delays at the time of the child's enrollment in the early intervention
system. DPH indicated that it used multiple developmental domains to
collect the outcome data. DPH also indicated that it did not include
outcome data for children with established medical conditions in the
reported data. On pages 30-31 of the FFY 2002 APR, DPH provided outcome
data on improved and sustained functional abilities for 8,750 children
who were discharged from early intervention services in 2002 and 9,700
children who were discharged in 2003. For 2003, the State reported the
following percentages of children with the same or improved functional
abilities in these developmental domains: Gross Motor (93.1%), Fine
Motor (91.1%), Expressive Language (90.0%), Receptive Language (89.1%),
Cognitive (90.6%), Social/Emotional (91.7%), and Adaptive/Self Help
(86.6%). OSEP appreciates the very specific responsive data collected by
the State.

DPH reported that it had limited capacity to provide clear and
comprehensive child outcomes information. DPH indicated that while the
State's early intervention system provided services for thousands of
children, it did not have the evaluative capacity necessary to provide
child specific outcome information. The State reported strategies
designed to enhance data collection and information in this area that
included: (1) the implementation of a Service Tracking Electronic
Payment (STEPS) data/payment system to collect early intervention system
process outcomes and to collect larger amounts of child specific
information for analysis; and (2) ongoing State involvement with the
Early Childhood Outcomes National Center (ECO). OSEP suggests that DPH
continue to pursue technical assistance regarding: (1) conceptual
decisions such as the purpose of the system, the key areas of child
functioning to be addressed, and the relationship of outcomes to the
nature and quantity of services received; (2) measurement decisions such
as including all children in the system or sampling; and (3) decisions
regarding data reporting methods to assist in the development and
implementation of the State's child and family outcome system. As part
of the FFY 2003 APR, OSEP looks forward to reviewing the State's
continued reporting of data (whether collected through sampling,
monitoring, individual IFSP review, or other methods) that demonstrate
the percentage of children participating in the Part C program who
demonstrate improved and sustained functional abilities in the five
developmental areas.

### Early Childhood Transition

Noncompliance was not identified in OSEP's Monitoring Report of June 21,
2000 for this cluster area. OSEP's February 2004 letter requested that
the State include in the FFY 2002 APR data on the numbers of children
for whom: (1) transition conferences are convened at least 90 days prior
to the child's third birthday; (2) the school district was notified of
the child's turning three, as required; and (3) transition plans were
included on IFSPs. In the FFY 2002 APR, DPH included data and
information regarding the inclusion of transition plans in IFSPs, but
did not provide data on timely transition conferences or notification of
school districts of children turning three. In the next APR, DPH must
provide compliance data under 34 CFR § 303.148(b) on the number of
children for whom transition conferences are convened, as required, at
least 90 days prior to the child's third birthday and on whether school
districts are notified by the lead agency as part of transition.

The data provided by DPH in the FFY 2002 APR indicated the following
area of potential noncompliance not previously identified by OSEP:
ensuring that IFSPs included the transition-related content required by
34 CFR §303.344(h). DPH reported data that indicated that 54 % of 268
files reviewed demonstrated that transition plans were completed and up
to date. Within 60 days of the date of this letter, DPH must review its
data and provide to OSEP an explanation of whether the files reviewed
were those of children at the age of transition and thus data indicating
noncompliance with 34 CFR §§ 303.148 and 303.344(h), or all children. If
the data indicate noncompliance, DPH must also submit to OSEP within 60
days of the date of this letter, a plan, including strategies, proposed
evidence of change, targets and timelines designed to ensure correction
of the noncompliance within a reasonable period of time, not to exceed
one year from the date OSEP accepts the plan.

***Conclusion***

As noted in the Early Childhood Transition cluster, within 60 days of
the date of this letter, DPH must review its data regarding
transition-related content in IFSPs, and provide to OSEP an explanation
of whether the files reviewed were those of children at the age of
transition and thus data indicating noncompliance with 34 CFR §§ 303.148
and 303.344(h), or all children. If the data indicates noncompliance,
DPH must also submit to OSEP, within 60 days from the date of this
letter, a plan that includes strategies, proposed evidence of change,
targets and timelines designed to ensure correction of the noncompliance
within a reasonable period of time, not to exceed one year from the date
OSEP approves the plan.

In the State's February 2005 submission of its 618 report, the State
must include confirmation that the State's December 2003 data plan was
implemented and that the data reported are accurate.

In the FFY 2003 APR (due March 31, 2005), the State must include:

1.  Data on whether initial IFSP meetings are convened within 45 days of
    referral to Part C. If the data indicate systemic noncompliance, a
    plan including strategies, proposed evidence of change, targets, and
    timelines, must be included in the FFY 2003 APR to ensure correction
    of noncompliance within a reasonable period of time, not to exceed
    one year from the date when OSEP accepts the plan;

2.  Data and analysis regarding compliance in the Family Centered
    Services cluster;

3.  The State's continued reporting of data (whether collected through
    sampling, monitoring, individual IFSP review, or other methods) that
    demonstrate the percentage of children participating in the Part C
    program who demonstrate improved and sustained functional abilities
    in the five developmental areas; and

4.  Data under 34 CFR § 303.148(b) on the number of children for whom
    transition conferences are convened, as required, at least 90 days
    prior to the child's third birthday and on whether school districts
    are notified by the lead agency as part of transition.

OSEP recognizes that the APR and its related activities represent only a
portion of the work in your State and we look forward to collaborating
with you as you continue to improve results for infants and toddlers
with disabilities and their families. If you have questions, please
contact Jacquelyn Twining-Martin at (202) 245-7558.

> Sincerely,
>
> Stephanie Smith Lee
>
> Director
>
> Office of Special Education Programs

cc: Ron Benham

Part C Coordinator