May 1, 2005

Honorable J. Nick Baird, MD

Director

Ohio Department of Health

246 North High Street

P.O. Box 118

Columbus, Ohio 43266-0188

Dear Director Baird:

The purpose of this letter is to inform you of the results of the Office
of Special Education Programs' (OSEP's) verification visit to Ohio. As
indicated in my letter to you of January 2004, OSEP is conducting
verification visits to a number of States as part of our Continuous
Improvement and Focused Monitoring System (CIFMS) for ensuring
compliance with, and improving performance under Parts B and C of the
Individuals with Disabilities Education Act (IDEA). We conducted a
verification visit to Ohio during the week of December 13, 2004.

The purpose of our verification reviews of States is to determine how
States use their general supervision, State-reported data collection,
and State-wide assessment systems to assess and improve State
performance; and to protect child and family rights. The purposes of the
verification visits are to: (1) understand how the systems work at the
State level; (2) determine how the State collects and uses data to make
monitoring decisions; and (3) determine the extent to which the State's
systems are designed to identify and correct noncompliance.

As part of the verification visit to the Ohio Department of Health
(ODH), the State's Part C Lead Agency, OSEP staff met with Ms. Debra
Wright, Bureau Chief and Ms. Debra Cheatham, the State's Part C
Coordinator, and members of ODH's early intervention staff who are
responsible for: (1) oversight of general supervision activities
(including monitoring, mediation, complaint resolution, and impartial
due process hearings); and (2) the collection and analysis of
State-reported data. Prior to and during the visit, OSEP staff reviewed
a number of documents[^1], including the State's Part C Application,
Self-Assessment, Improvement Plan, and Annual Performance Reports
(APRs), and submissions of data under section 618 of the IDEA. OSEP also
conducted conference calls on November 9^th^ and 10^th^ 2004, with
members of the Part C Steering Committee and with families in Ohio, to
hear their perspectives on the strengths and weaknesses of the State's
systems for general supervision and data collection and reporting.

The information that Ms. Wright and her staff provided during the OSEP
visit, together with all of the information that OSEP staff reviewed in
preparation for the visit, greatly enhanced our understanding of ODH's
systems for general supervision, and data collection and reporting for
the Ohio Help Me Grow System (HMG).

*General Supervision:*

In looking at the State's general supervision system, OSEP collected
information regarding a number of elements, including whether the State:
(1) has identified any barriers (e.g., limitations on authority,
insufficient staff or other resources, etc.) that impede the State's
ability to identify and correct noncompliance; (2) has systemic,
data-based, and reasonable approaches to identifying and correcting
noncompliance; (3) utilizes guidance, technical assistance, follow-up,
and---if necessary---sanctions, to ensure timely correction of
noncompliance; (4) has dispute resolution systems that ensure the timely
resolution of complaints and due process hearings; and (5) has
mechanisms in place to compile and integrate data across systems (e.g.,
618 State-reported data, due process hearings, complaints, mediation,
large-scale assessments, previous monitoring results, etc.) to identify
systemic issues and problems.

OSEP believes that ODH's systems for general supervision constitute a
reasonable approach to the identification and correction of
noncompliance. However, OSEP has concerns based on interviews with
ODH/HMG personnel and a review of the revised ODH/HMG Compliance
Monitoring Tool, that ODH/HMG does not monitor to determine if eligible
children receive early intervention services that are in their
Individualized Family Service Plans (IFSPs). In addition, without
collecting data at the local level, OSEP cannot determine whether
ODH/HMG's monitoring system is identifying and correcting noncompliance.

OSEP learned through interviews with ODH/HMG staff that Ohio has
significant State challenges. Ohio has 88 decentralized and autonomous
counties, which makes implementing a consistent monitoring process
difficult. Each county has a different system of early intervention
services depending on funds raised through local levies, due to reduced
State funding. The Office of Mental Retardation and Developmental
Disabilities (OMRDD) also provides early intervention services under HMG
and those services are offered through 88 separate county boards. Based
on OSEP's 2001 Monitoring Report that identified areas of noncompliance,
and the State's subsequent reporting of its monitoring data in its
Federal Fiscal Year (FFY) 2001 and 2002 Annual Performance Reports
(APRs), Ohio made substantial changes to its general supervision and
data collection systems in order to address the challenges and to
strengthen and improve oversight of the Part C system.

ODH/HMG reported that it reorganized the general supervision system in
September 2004. The State developed four separate teams that included:
(1) the Monitoring Work Team that conducts data collection through
written and electronic format, verifies data through local on-site
reviews, and compiles data into a report format; (2) the Technical
Assistance Work Team that provides technical assistance based on
technical assistance plans developed by a member of the team and aligned
with monitoring, and identifies State and local training needs and
assists with training; (3) the Training and Education Work Team that
develops specialized training in response to identified needs, and
coordinates core HMG training; and (4) the Outreach and Communications
Work Team that develops child find outreach efforts, coordinates
communication initiatives and develops and implements technical
assistance plans that address monitoring findings and other State and
local training needs. OSEP recognizes Ohio's efforts in redesigning its
system in order to better address the identification and correction of
noncompliance through monitoring, technical assistance and training.

OSEP learned through interviews with ODH/HMG personnel that Ohio
monitors, through the Help Me Grow System Review (HMGSR), each of the 88
counties every 2 years. The Family and Child First Council located in
each county and the HMG Project Director for that county are responsible
for establishing and implementing procedures to ensure continuous
improvement in the HMG system. The monitoring process includes a
self-assessment and a site visit. The two-day site visit includes record
reviews, interviews and/or focus groups with representatives from
administrative, consumer, and provider groups, and an exit meeting for
technical assistance and long term strategic planning. The HMG
Compliance Monitoring Tool includes 11 program areas and 82 performance
and compliance indicators. Additional monitoring completed by ODH/HMG
prior to the on-site visit includes: (1) a review of seven records from
each county monitored that are randomly selected from the State's
database; (2) a parent focus group; (3) a consumer call made to the
county to determine how the county processes a call through the central
intake and referral system; and (4) a review of Virtual System Record
Reviews in the Early Track Data System. The Virtual System Record
Reviews include data from 17 of the 82 indicators from monitoring. The
17 indicators relate directly to Part C requirements and timelines such
as referral and initial IFSP timelines, services in natural environments
and transition planning.

The HMG Compliance Monitoring Tool also includes a scoring system for
each indicator based on its importance and relation to Part C
requirements. It also includes general guidance to assist the monitoring
team in reviewing and documenting the data and information reviewed.
However, OSEP could not find an indicator in the HMG Compliance
Monitoring Tool that reviews whether Part C services on the
Individualized Family Service Plan (IFSP) are being provided. OSEP
acknowledges that ODH/HMG is using its monitoring data to identify
State-wide trends in meeting certain Part C requirements, and to
determine root causes in order to focus its monitoring and technical
assistance efforts on systemic improvement; however, OSEP requires State
programs to ensure that services on the IFSP are being provided.
Therefore, ODH/HMG must revise its Compliance Monitoring Tool and
Virtual System Record Reviews to incorporate this compliance indicator
and submit the revised tools to OSEP by June 1, 2005. In addition, as
noted in OSEP's April 2005 response to the State's November 2004 final
Progress Report data, ODH must provide to OSEP by June 1, 2005 data
indicating whether eligible children are receiving the Part C services
on their IFSPs. If the data indicate noncompliance, ODH/HMG must submit
to OSEP by June 1, 2005 its plan to ensure correction as soon as
possible.

Within 10 business days following an onsite visit to the HMG county
system, the ODH/HMG provides a monitoring report. The report requests
submission of a Continuous Improvement Plan (CIP) within 4 weeks. Once
the CIP is approved by ODH/HMG, technical assistance is prioritized and
more focus is given to counties with lower scores on the monitoring
report. ODH/HMG provides technical assistance, with two visits to a
county per year, and the development of a technical assistance report by
the technical assistance team representative. The technical assistance
representative for the county reviews quarterly monitoring reports
through the Virtual Data System Reviews and provides ongoing technical
assistance and training to the counties until the next on-site visit.

As reported by ODH/HMG, 55 of the 88 counties did not receive on-site
monitoring in 2004, but were required to submit a self-assessment. As
part of the revised system, ODH/HMG is moving toward a performance-based
funding formula and is requiring self-assessments to be completed by all
counties in order to receive 2005 funding. This past year, ODH/HMG
reviewed the self-assessments, required "special condition improvement
plans" if noncompliance was identified and approved the plans prior to
releasing funds for each county. ODH obtained baseline data from the
self-assessments and the Virtual Data System Quarterly Reports in order
to learn which counties had the most need for additional focused
monitoring, technical assistance and training. Additional data
collection in 2005 will include data from the State-wide IFSP that was
implemented in the fall of 2004, including the transition checklist that
documents timelines for transition planning, and outcome data that
documents data on functional abilities. ODH will use that data to
develop a focused monitoring system in 2005.

As confirmed by OSEP's review of ODH/HMG monitoring files, and
interviews with ODH/HMG staff, ODH/HMG is making a number of compliance
findings regarding such Part C requirements as meeting the 45-day
timeline for development of initial IFSPs, including evaluations and
assessments, and timely transition planning. The CIP approved by ODH/HMG
requires correction of noncompliance within a year of identification.
OSEP also learned through interviews with ODH/HMG staff and review of
ODH/HMG monitoring files, that ODH/HMG conducts follow-up technical
assistance visits, as necessary, to local counties in order to ensure
correction of identified noncompliance.

ODH/HMG has established a list of sanctions that may be imposed if a
program fails to take the requisite corrective actions specified in the
CIP. For counties with persistent noncompliance, ODH will partner with
the other agencies involved (i.e., OMR/DD and parent groups) to work
with the county or local provider to determine the reason for the
noncompliance. If persistent noncompliance continues, ODH/HMG and the
State Interagency Coordinating Council determine if funding should be
withheld or withdrawn. OSEP asks that ODH/HMG keep OSEP informed
concerning its progress in ensuring correction in those counties through
its APR, and if ODH/HMG determines that it cannot, without the use of
sanctions, ensure timely correction of noncompliance in some counties,
ODH/HMG must utilize sanctions, when appropriate, to achieve timely
compliance.

OSEP also reviewed ODH/HMG's system for the resolution of State
complaints, due process hearings and mediation. ODH/HMG reported that 15
complaints were filed from July 1, 2002-June 30, 2003. All complaints
were addressed within timelines. There were no requests for mediation or
due process. Review of complaints found that 11 of the 15 complaints
were from the same program that asked families to file complaints about
insufficient funding from the State for the program. Based on interviews
with the Part C Coordinator, it appears that the program was providing
additional services not approved under their contract with the State
office and the State office had to remove the program. ODH/HMG has
continued to provide technical assistance to its providers with approved
contracts on allowable early intervention services. In addition, ODH/HMG
has continued to report correction data from its monitoring of 15
counties in 2003, on whether parents are notified of their rights in a
clear and understandable manner. OSEP looks forward to reviewing the
data on procedural safeguards in the FFY 2003 APR.

*Data Collection under Section 618 of the IDEA:*

In looking at the State's system for data collection and reporting, OSEP
collected information regarding a number of elements, including whether
the State: (1) provides clear guidance and ongoing training to local
programs/public agencies regarding requirements and procedures for
reporting data under section 618 of the IDEA; (2) implements procedures
to determine whether the individuals who enter and report data at the
local and/or regional level do so accurately and in a manner that is
consistent with the State's procedures, OSEP guidance, and section 618;
and (3) implements procedures for identifying anomalies in data that are
reported, and correcting any inaccuracies; and (4) has identified any
barriers, (e.g., limitations on authority, sufficient staff or other
resources, etc.) that impede the State's ability to accurately, reliably
and validly collect and report data under section 618.

Based on information provided both prior to and during the verification
visit, OSEP concludes that the State's system for collecting and
reporting data reasonably ensures the accuracy of the data ODH/HMG
reports to OSEP under IDEA section 618.

In interviews with ODH/HMG staff, OSEP learned that the web-based Early
Track 2.1version allows counties the ability to access Early Track
anywhere in the user's county and thus move beyond the need for a
centralized data entry function. ODH/HMG is working with counties to
move towards a decentralized system. MR/DD data comes in at the local
level and the MR/DD personnel use the web-based system. Due to some
limitations with the 2.1 version (slow and not user friendly), ODH is
developing an Early Track 3.0 version due in Spring 2005 that will match
OSEP's 618 data requirements exactly. The Early Track 3.0 version will
move all counties to a decentralized system, and will include edit
enhancements such as the development of data reports that identify
inconsistencies in data reporting, and the development of a data quality
assurance plan. ODH/HMG Early Track 3.0 will be implemented in Spring
2005 and mandatory training on the revised system will be provided to
HMG Project Directors and County Administrators.

ODH/HMG personnel reported that they have implemented a State-wide
web-based birth to three data collection and tracking system. ODH/HMG
schedules ongoing State and regional trainings for counties that are
less proficient with data systems and do not have adequate staff, as
well as to accommodate staff turnover. A master trainer for the Early
Track System conducts training at the local level. Four times a year,
five regional trainings are held for all counties. A training manual is
provided to each county and the HMG Project Director in each county also
receives an electronic version of the training manual. Early Track memos
regarding the data system and updates are sent to the Early Track County
Administrators and HMG Project Directors on a regular basis. Additional
technical assistance on the data system is provided through: (1) data
training refresher classes; (2) a monthly Early Track newsletter; and
(3) emails to users that address questions and answers about the Early
Track System.

ODH/HMG has developed a data team at the State level to assist with data
development, collection and research. In previous years, ODH's data
manager was located in a separate office which made communication and
changes to the system difficult. Since the data manager moved to the HMG
office with a data research team, ODH/HMG personnel report that the data
has increased in validity and reliability. The data team is working
closely with the monitoring team to complete a needs assessment to
determine county needs so that deficiencies can be identified and
technical assistance provided. The State has developed various reports
to track timely entry of data into the system.

OSEP learned through interviews with ODH/HMG personnel that the Security
Administrator is responsible for authorizing application users within
the ODH, and one county system administrator for each of the 88
counties. The county system administrator will be responsible for
authorizing all the users in the county and the Security Administrator
will be responsible for reviewing and approving all requests for access
to the Early Track 2.1 and 3.0 database. An individual is designated
with an access level and service program in their county. An
individual's viewing and maintenance capabilities are implemented based
upon that access level/service program combination. At the State level,
individuals without an ODH username and password are not allowed to
maintain any information in the database. Individuals with an ODH
username and password may view all of the reports identified within the
Early Tack 2.1 and 3.0 applications. Reports at the State level do not
display personally identifiable information.

In conclusion, as referenced under General Supervision, ODH/HMG must
revise its Compliance Monitoring Tool and Virtual System Record Reviews
to incorporate a compliance indicator that reviews whether Part C
services on the IFSP are being provided. ODH/HMG must submit the revised
tools to OSEP by June 1, 2005. In addition, as noted in OSEP's April
2005 response to the State's November 2004 final Progress Report data,
ODH must provide to OSEP by June 1, 2005 data indicating whether
eligible children are receiving the Part C services on their IFSPs. If
the data indicate noncompliance, ODH/HMG must submit to OSEP by June 1,
2005 its plan to ensure correction as soon as possible.

We look forward to collaborating with Ohio as you continue to work to
improve results for children with disabilities and their families.

> Sincerely,
>
> Patricia J. Guard
>
> Acting Director
>
> Office of Special Education Programs

cc: Debra Wright

Bureau Chief

Debra Cheatham

Part C Coordinator

[^1]: Documents reviewed as part of the verification process were not
    reviewed for legal sufficiency but rather to inform OSEP's
    understanding of your State's system.