September 14, 2001

Honorable Antonia C. Novello, M.D.

Commissioner

Department of Health

Corning Tower, Room 1408

Empire State Plaza

Albany, New York 12237

Honorable Richard P. Mills

Commissioner of Education

New York State Education Department

111 Education Building

89 Washington Avenue

Albany, New York 11234

Dear Commissioner Novello and Commissioner Mills:

The U.S. Department of Education's Office of Special Education Programs
(OSEP) conducted a review in New York during the weeks of February 8,
1999 and April 19 - 23, 1999. The purpose of that visit was to assess
the New York State Education Department (NYSED) and New York Department
of Health's (NYDOH) compliance with the implementation of the
Individuals with Disabilities Education Act (IDEA), and assisting the
State in developing strategies to improve results for children with
disabilities. The 1997 Amendments to the IDEA focus on "access to
services" as well as "improving results" for infants, toddlers, children
and youth with disabilities. In the same way, the Continuous Monitoring
Improvement Process is designed to focus Federal, State and local
resources on improved results through a working partnership between
OSEP, NYSED, NYDOH, and parents and advocates in New York.

A critical aspect of the Continuous Monitoring Improvement Process is
collaboration between a Steering Committee of broad-based
constituencies, including representatives from NYDOH, NYSED and OSEP.
The Steering Committee is asked to assess the effectiveness of State
systems for ensuring improved results for children with disabilities and
protection of individual rights, and to assist in the design and
coordination of improvement strategies. The Introduction section of this
report provides a more detailed description of the process used in New
York.

OSEP's review placed a strong emphasis on those areas that are most
closely associated with positive results for children with disabilities.
OSEP focused on five *Cluster Areas* for Part C of the IDEA (services
for children aged birth through 2) -- Child Find and Public Awareness,
Family Centered Services, Early Intervention Services in the Natural
Environment, Early Childhood Transition, and General Supervision.
Components were identified for each *Cluster Area*, and were used by
OSEP and the Steering Committee as a basis to review the State's
performance.

Typically an OSEP monitoring report would include OSEP's review of both
Parts B and C of IDEA. However, due to the unexpected illness and
subsequent retirement of the State contact and primary writer for the
Part B section of the New York report, we were unable to reconstruct the
findings related to Part B from the 1999 monitoring. Thus, this report
does not include the OSEP findings related to the Part B program but
reflects only the strengths, areas of noncompliance and areas of
suggested improvement for the Part C program administered by NYDOH. OSEP
has developed a collaborative plan with NYSED and NYDOH to move forward
in the continuous improvement monitoring process to the improvement
planning phase of the process. OSEP and NYSED have agreed on the issues
that continue to be areas of concern for the state as well as the areas
of strength.

Through a joint steering committee process representing stakeholders
from NYDOH and NYSED, OSEP will move forward to the improvement planning
process that will outline the strategies employed to improve results for
children and families since the OSEP visit in April of 1999. Once the
plans are finalized and approved by OSEP, they will be available on the
Department of Education's web site. Since Part C in New York has never
been monitored by OSEP, it was decided to issue that portion of the
Report to be used as a baseline for the improvement planning process.

The enclosed Report addresses strengths noted in New York, areas that
need improvement, and areas that require corrective action because they
represent noncompliance with the requirements of IDEA. Included in the
body of the Report, you will find an Executive Summary of information,
an Introduction including background information, and a description of
the issues around the *Cluster Areas*.

We understand that this Report will be shared with members of the
Steering Committee, the State Interagency Coordinating Council and other
constituents. OSEP will work with your Steering Committee to develop
corrective actions and improvement strategies to ensure improved results
for children with disabilities.

Thank you for the assistance and cooperation provided by your staff
during our review. Throughout the course of the review, Mr. Dennis
Murphy and Dr. Donna Noyes were responsive to OSEP's request for
information, and provided access to necessary documentation that enabled
OSEP staff to work in partnership with the Steering Committee to better
understand the State's system for implementing IDEA. A significant
effort was made to arrange the public input process during the
validation planning week and as a result of their efforts, OSEP obtained
information from a large number of parents, advocates, agency personnel,
regional administrators, local health clinic and program administrators,
service providers, and interagency collaborators.

Thank you for your continued efforts toward the goal of achieving better
results for infants, toddlers, children and youth with disabilities in
New York. Since the enactment of IDEA and its predecessor, the Education
of All Handicapped Children Act, one of the basic goals of the Law,
ensuring that children with disabilities are included in their
communities, has largely been achieved. Today, families can have a
positive vision for their child's future.

Due a variety of internal problems, the issuance of this report has been
significantly delayed. OSEP apologizes for this delay and we accept
responsibility for our failure to issue these findings in a more timely
manner. A comprehensive internal review of this incident has resulted in
significant modifications to our internal procedures related to Part B
and Part C monitoring activities. We commend Larry Gloeckler for his
willingness to assist us in learning from this monitoring experience and
his commitment to improving results for children and youth with
disabilities while awaiting the release of this report and the new OSEP
activities related to Improvement Planning.

While agencies and programs have made great progress, significant
challenges remain. Now that children with disabilities and their
families are receiving services, the critical issue is to place greater
emphasis on attaining better results for those individuals. To that end,
we look forward to working with you in partnership to continue to
improve the lives of individuals with disabilities.

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

Enclosures

Cc: Dr. Donna Noyes

Mr. Lawrence Gloeckler

**[EXECUTIVE SUMMARY]{.underline}**

**[NEW YORK MONITORING 1999]{.underline}**

The attached report contains the results of the first two steps
(Validation Planning and Validation Data Collection) in the Office of
Special Education Programs' (OSEP) Continuous Improvement Monitoring of
the Individuals with Disabilities Education Act (IDEA), Part C, in the
State of New York during the weeks of February 8, 1999 and April 19,
1999. The process is designed to focus resources on improving results
for infants, toddlers and children with disabilities and their families
through enhanced partnerships between the State agencies, OSEP, parents
and advocates. The Validation Planning phase of the monitoring process
included a series of public input meetings with guided discussions
around core ideas of IDEA. As part of the public input process OSEP and
the State made efforts to include multi-cultural and underrepresented
populations. The Validation Data Collection phase included interviews
with parents, agency administrators, regional and local program
administrators, service providers and service coordinators, and reviews
of children's records. Information obtained from these data sources was
shared in a meeting attended by staff from the New York State Department
of Health (NYDOH) and the Steering Committee.

The Report includes a detailed description of the process utilized to
collect data, and to determine strengths, areas of non-compliance with
IDEA, and suggestions for improved results for children.

**[Early Intervention Services for Infants and Toddlers with
Disabilities:]{.underline}**

**[Part C of IDEA]{.underline}**

**Strengths**

OSEP observed the following strengths:

-   Intra-agency and Interagency Coordination to Ensure Compliance

-   Implementation of an Integrated Computerized Data Base System

-   Computerized Data System to Improve Child Find Efforts

-   Coordination of Resources to Enhance Child Find and Public Awareness

-   Child Care and Assistive Technology Initiatives

-   Development of Service Guidelines to Promote Individualized
    Determinations

-   Enhancing Local Capacity through Local Interagency Coordinating
    Councils

-   Parent Guides to Enhance Awareness and Increase Participation in the
    Early Intervention System

-   Parent Involvement Subcommittee of State Early Intervention
    Coordinating Council

-   Local Partnerships Enhance Transition Efforts

**Areas of noncompliance**

OSEP observed the following areas of noncompliance:

-   Failure to Monitor Participating Programs and Agencies Consistent
    with Part C Application

-   Deficiencies Identified through Monitoring Not Corrected

-   Delays in the Provision of Technical Assistance to Programs and
    Agencies

-   Failure to Issue a Written Decision on Complaints within the 60-Day
    Timeline and to Provide the Appropriate Follow-up Activities to
    Ensure Compliance

-   Failure to Hold IFSP Meetings within 45 Days

-   Failure to Provide Services in Natural Environments

-   All Service Coordination Activities are not Provided to Families

-   Failure to Identify and Document Family Needs, Supports and Services
    on the IFSP

-   Failure to Ensure Smooth and Effective Transitions

**[NEW YORK MONITORING REPORT]{.underline}**

#### [TABLE OF CONTENTS]{.underline}

**INTRODUCTION [1](#introduction)**

Administrative Structures and Children Served
[1](#administrative-structures-and-children-served)

Validation Planning and Data Collection
[2](#validation-planning-and-data-collection)

Improvement Planning [3](#improvement-planning)

I. PART C: GENERAL SUPERVISION [4](#i.-part-c-general-supervision)

A. AREAS OF STRENGTH [5](#a.-areas-of-strength)

B. AREAS OF NONCOMPLIANCE [7](#b.-areas-of-noncompliance)

C. SUGGESTIONS FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR
FAMILIES
[11](#c.-suggestions-for-improved-results-for-infants-toddlers-and-their-families)

II\. PART C: CHILD FIND/PUBLIC AWARENESS
[13](#ii.-part-c-child-findpublic-awareness)

A. AREAS OF STRENGTH [13](#a.-areas-of-strength-1)

B. SUGGESTIONS FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR
FAMILIES
[14](#b.-suggestions-for-improved-results-for-infants-toddlers-and-their-families)

III\. PART C: EARLY INTERVENTION SERVICES IN\
NATURAL ENVIRONMENTS
[17](#iii.-part-c-early-intervention-services-in-natural-environments)

A. AREAS OF STRENGTH [18](#a.-areas-of-strength-2)

B. AREAS OF NONCOMPLIANCE [19](#b.-areas-of-noncompliance-1)

C. SUGGESTION FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR
FAMILIES
[22](#c.-suggestion-for-improved-results-for-infants-toddlers-and-their-families)

IV\. PART C: FAMILY-CENTERED SYSTEM OF SERVICES
[24](#iv.-part-c-family-centered-system-of-services)

A. AREAS OF STRENGTH [25](#a.-areas-of-strength-3)

B. AREA OF NONCOMPLIANCE [26](#b.-area-of-noncompliance)

V. EARLY CHILDHOOD TRANSITION [28](#v.-early-childhood-transition)

A. AREA OF STRENGTH [28](#a.-area-of-strength)

B. AREA OF NONCOMPLIANCE [29](#b.-area-of-noncompliance-1)

# INTRODUCTION

The general resident population in New York for 1995 was 18,178,000,
based on an analysis of the census data. The racial/ethnic composition
of this population was reported as 14,025,999 whites, 3,249,000 blacks,
2,372,000 Hispanics, 864,00 Asian/pacific islanders, and 57,000 American
Indian, Eskimo and Aleut. New York has one of the highest per capital
incomes in 1995. The 1998 census data estimates some 737, 354 children,
birth to three, residing in the State which reflects a steady increase
in the number of children, birth to three. The State has put in place
several key initiatives to minimize the health disparity among
underrepresented populations in an effort to improve the overall health
status and wellbeing of all children birth to three. The Children\'s
Health Insurance Benefit Package expanded health and medical coverage to
moderate and low-income families with children, and the State
established standard criteria to ensure that all children have a medical
home[^1] and services are coordinated with the Part C system for those
children found eligible. In 1995, eighty-two percent of the children in
New York were immunized by age 2, compared to the national norm of
seventy-eight percent. The infant mortality rate and the incidence of
low birth-weight, two high- risk factors that impact on acquired and
developmental disabilities and delays, were both reported to be 7.6,
which is equal to or below the national norm.

## Administrative Structures and Children Served

**[The Part C System]{.underline}**

The New York Department of Health (NYDOH) is designated by State law as
the lead agency for the implementation of the State\'s Part C program.
NYDOH is responsible for the general supervision and monitoring of 57
municipalities and New York City, in addition to 900 agencies and 2400
individual providers.

NYDOH administers the Early Intervention Program through its Bureau of
Child and Adolescent Health. NYDOH sets programmatic and fiscal
standards and regulations to ensure compliance, among both public and
private providers, in the implementation of Part C of IDEA. NYDOH fully,
partially or through in-kind contributions supports 45 state-level
positions and ten regional positions to provide program development and
administrative oversight, program evaluation, fiscal operations and to
address legal issues. Local health departments assist the State in the
implementation of the early intervention system in 54 of 57
municipalities. NYDOH contracts with private agencies to administer
early intervention services in the other three municipalities, and, in
New York City, NYDOH contracts with the State Department of Mental
Health.

The U.S. Department of Education\'s Data Analysis System reported, in
December 1998, that in New York 20,592 children, or 2.75% of all
children 0-3 in New York, were receiving Part C services as a result of
a developmental delay or established condition. The number of children
in the Part C system reported to be under one year of age was 1,410,
there were 4,932 children between the ages of one and two, and 15,250
were between two and three years of age.

######### 

## Validation Planning and Data Collection

In preparation for the Validation Planning visit, OSEP reviewed the
State's current Part C application, annual performance reports, annual
child-count data, and interagency data that reflected the health status
of the birth-to-three population. OSEP staff solicited input from
representatives of Parent Training and Information Centers and other
collaborating agencies, and reviewed requests for complaints from
constituents.

During the week of February 8, 1999, OSEP and the Steering Committee
conducted public stakeholder focus meetings in New York City,
Westchester, Long Island, Buffalo, Syracuse, and Saratoga to obtain
further information about issues and concerns regarding IDEA service
delivery. To ensure that the needs of its constituent groups were
addressed, and that sufficient space was available to accommodate those
who wished to attend the focus meetings, NYDOH provided an opportunity
for its constituents to prioritize or pre-select the focused discussion
in which they wished to participate. They could choose from five areas
under Part C of IDEA (services for children birth through 2) - Child
Find and Public Awareness, Family Centered Services, Early Intervention
Services in the Natural Environment, Early Childhood Transition, and
General Supervision. Simultaneously individual focus meetings on each
cluster area were conducted at each location. Attendance in these
locations ranged in number from 100 to as many as 300 participants.

Preliminary results from the public focus meetings as well as the
results of the self-assessment conducted by NYDOH were shared with the
Steering Committee at the end of the week. Recommendations for
strategies and sites that might be visited when OSEP returned were also
discussed, and the next steps in the joint planning for OSEP's
Validation Data Collection Visit were identified.

###### 

OSEP visited the State during the week of April 19, 1999 to collect
additional information on issues identified during the Validation
Planning process. As part of its review, OSEP collected information
concerning the status of NYDOH's implementation of the 1997 Amendments
to the IDEA.

During its onsite Validation Data Collection, OSEP teams collected data
in New York City and Suffolk, Onondaga, Schoharie, Rensselaer, and
Washington Counties. These sites represent rural and suburban areas
where resources for service delivery for children with disabilities may
vary considerably and urban areas with their diverse populations.

At these sites, OSEP reviewed children's records, including Individual
Family Service Plans (IFSPs) and minutes from IFSP meetings. OSEP also
reviewed local policies and procedures. OSEP conducted interviews with
personnel responsible for implementation of Part C, and included local
service providers, service coordinators, administrators and related
service personnel as appropriate. OSEP selected service coordinators who
serve children with disabilities in a variety of settings and who are
involved in the development or implementation of IFSPs.

## Improvement Planning

On Thursday October 12, 2000, OSEP staff met with representatives of
NYDOH's Early Intervention Program, Donna Noyes, Denise Berletic, Brenda
Knudson Chouffi, Elizabeth Kerins and Daniel Rowland to discuss the
progress being made to address the concerns identified in this report.
In response to this report, NYDOH will develop an action plan addressing
areas of noncompliance as identified in the report.

Approximately 60 days after the issuance of this report, OSEP will visit
New York to work with NYDOH to finalize an improvement plan. During this
visit, OSEP will assist the Steering Committee in identifying strategies
that exist or would be required to implement changes, sources of
technical assistance, timelines for completing strategies, and methods
for evaluating the effectiveness of the improvement plan.

# I. PART C: GENERAL SUPERVISION

The State lead agency is responsible for developing and maintaining a
Statewide, comprehensive, coordinated, multidisciplinary, interagency
early intervention system. Administration, supervision and monitoring of
the early intervention system are essential to ensure that each eligible
child and family receives the services needed to enhance the development
of infants and toddlers with disabilities and to minimize their
potential for developmental delay. Early intervention services are
provided by a wide variety of public and private entities. Through
supervision and monitoring, the State ensures that all agencies and
individuals providing early intervention services meet the requirements
of IDEA, whether or not they receive funds under Part C.

While each State must meet its general supervisory and administrative
responsibilities, the State may determine how that will be accomplished.
Mechanisms such as interagency agreements and/or contracts with other
State-level or private agencies can serve as the vehicle for the lead
agency's implementation of its monitoring responsibilities. The State's
role in supervision and monitoring includes: (1) identifying areas in
which implementation does not comply with Federal requirements; (2)
providing assistance in correcting identified problems; and (3) as
needed, using enforcing mechanisms to ensure correction of identified
problems.

**[Validation Planning and Data Collection]{.underline}**

As part of the validation planning phase, OSEP reviewed the State
Interagency Coordinating Council\'s Part C Annual Reports for 1994-1998,
the applications for Federal Part C funds for the period 1995-98,
complaints and letters from families and advocates, requests for
Secretarial Review, policies, procedures and guidance documents. OSEP\'s
review of these documents provided a framework for the review of the
State\'s self-assessment and afforded a greater understanding of
NYDOH\'s Part C statewide early intervention system.

The State's steering committee played an integral role, in collaboration
with State staff, in the development of the Self-Assessment. The
Self-Assessment identified several accomplishments in the area of
general supervision. These accomplishments included: (1) intra-agency
collaboration within NYDOH to enhance child find and public awareness
efforts; (2) interagency agreements with the NYSED and the Office of the
Advocate for Persons with Disabilities; (3) utilization of monitoring
protocols and evaluation tools; (4) implementation of guidance documents
and clinical practice guidelines in response to identified areas of
concern; and (5) contractual arrangements with the New York State
Association of Counties and the New York State Dispute Resolution
Association Inc. to provide technical assistance and training.

Areas of concern identified in the Self-Assessment included: (1) the
need to improve collaborative efforts with other State level agencies,
such as the Office of Mental Health and the Office of Children and
Families; (2) the need to resolve issues regarding IFSP development and
implementation; (3) the need to improve the response time in answering
complaints; (4) the lack of timely reimbursement for services; (5) the
need to monitor all programs; and (6) the implementation of corrective
actions, enforcement and technical assistance. The State Interagency
Coordinating Council identified areas for improvement including data
analysis to identify gaps and trends in the service delivery process,
and concerns with the level of parent involvement.

During the public input process, parents, providers, local
administrators and stakeholders expressed concern in the following
areas: (1) the need for consistency and timeliness in the monitoring
process so that timely feedback is provided to agencies and programs;
(2) the need for timely technical assistance to address concerns
regarding the provision of services, particularly in the area of natural
environments; and (3) the need for improved communication between the
local programs and the State to ensure timely access to information
regarding changes in Federal and State laws, regulations and/or
policies.

Based on the information from the Self-Assessment, the public input
process and a review of monitoring reports, local applications,
contracts, and State and local procedures, OSEP identified the following
areas of concern: (1) monitoring of all programs in a timely manner; (2)
implementation and evaluation of technical assistance to ensure
compliance; (3) ensuring compliance with Part C requirements regarding
due process and complaints; and (4) timely reimbursement for services.

Through actions forged by State staff and the State Early Intervention
Coordinating Council, NYDOH has already begun to identify, analyze, and
address several of the areas of concern identified during the validation
planning and data collection phase of OSEP's continuous monitoring
process.

To investigate the concerns regarding monitoring activities identified
during the validation planning process, OSEP reviewed children's early
intervention records, State and local policies and procedures,
monitoring reports and interviewed State staff, local program
administrators, service coordinators, service providers, interagency
collaborators and parents.

OSEP reviewed and analyzed the data and identified the following areas
of strength, noncompliance, and suggestions for improved results for
infants and toddlers and their families.

## A. AREAS OF STRENGTH

**1. [Intra-agency and Interagency Coordination to Ensure
Compliance]{.underline}**

NYDOH\'s Part C application for fiscal year 1998 funds described State
efforts to maintain and implement a coordinated intra-agency and
interagency system for the provision of early intervention services. Key
intra-agency administrators within NYDOH provide from 5% to 75% of their
time to assist the State in carrying out its general supervision and
administration responsibilities. These intra-agency administrators play
a key role with the development of policies, oversight for programs,
financial management, budgeting and internal accounting operations to
assure consistency among Federal, State and local policies, procedures
and operations.

The State Interagency Early Intervention Coordinating Council (SICC)
provides ongoing support to assist NYDOH in the implementation of the
Part C system. The SICC has an executive committee to ensure that
time-sensitive issues are addressed and to provide overall guidance and
support to the four standing committees: training, data parent
involvement, and quality improvement. The data committee played a
significant role in data analysis, presentation of the base-line data,
identification of issues, and incorporating these components into the
development of the Self-Assessment. As a result of this data analysis,
NYDOH's approved application for FY 1999 Part C funds targeted specific
statewide initiatives to address some of the areas of non-compliance.
These statewide initiatives identified in the Part C application
include: (1) targeting public awareness efforts in the medical community
and the dissemination of clinical practice guidelines; (2) training
regarding the IFSP process; (3) technical assistance to address regional
and cultural diversity; (4) family initiatives that provide parent
mentoring and a process to solicit parent input; (5) enhancing the
mediation process; and (6) expediting the reimbursement process.

In addition, NYDOH has formalized interagency agreements with NYSED and
the Office of Mental Health. These agreements allow the agencies to
approve prospective programs and providers, to provide early
intervention services under the auspices of their respective agencies,
to monitor program activities, and to submit to NYDOH quarterly and
annual reports on the status of monitoring, corrective actions and
technical assistance, and dispute resolution activities.

OSEP and the State will use the outcomes of the intra-agency and
interagency initiatives and other activities in the development and
implementation of the State's improvement plan.

**2. [Implementation of an Integrated Computerized Database
System]{.underline}**

NYDOH used Federal Part C funds to develop a computerized database, Kids
Integrated Data System, that allows for the integration of demographic
and family information on Part C-eligible children who may also be
receiving services from the Infant-Child Health Assessment Program, or
the Physically Handicapped Children's Program. The Kids Integrated Data
System also allows for the tracking of potentially eligible children
through the use of a diagnostic coding system based on the International
Classification of Diseases (ICD) 9^th^ Revision. The Data System also
allows for the monitoring of at-risk children, to determine their
developmental progress over time, and to refer them to the Part C system
when appropriate. The Kids Data System includes a billing module that
allows the State to record and track reimbursement sources such as
private insurance, Medicaid, Part C and other State Department of Health
funds. NYDOH is able to generate various reports from this system to
identify strengths and challenges within the various regions, and to
provide guidance to the 57 municipalities and New York City in the
management of the service delivery system. NYDOH compiled the data from
the 57 municipalities and New York City over a four-year period and
created an annual report that confirmed several areas of concern. NYDOH
will train local administrators on how to utilize the database to assess
local performance.

## B. AREAS OF NONCOMPLIANCE

**1. [Failure to Monitor Participating Programs and Agencies Consistent
with Part C Application]{.underline}**

34 CFR §303.501 requires that all programs and activities used by the
State to implement the statewide early intervention system be monitored
to ensure that the State is in compliance with Part C of IDEA. The lead
agency is required to adopt and use proper methods of administering the
program including: monitoring, correcting deficiencies, enforcing
obligations imposed on those agencies under Part C, and providing
technical assistance, if necessary.

As discussed below, OSEP determined that NYDOH has not fulfilled its
obligation for general administration and supervision. NYDOH has not
implemented monitoring procedures as specified in its approved Part C
application.

OSEP reviewed NYDOH\'s monitoring protocols to ascertain if the
procedures outlined were adequate to determine compliance with Part C
requirements. OSEP\'s review indicated that, on their face, the existing
monitoring protocols contained all the necessary components to determine
compliance with all Part C requirements. Although State policy,
monitoring protocols and the approved FY 1998 Federal Part C application
indicated that participating programs would be monitored on an annual
basis, OSEP's review of NYDOH's monitoring log and monitoring reports
indicated that not all programs and agencies used by the State in the
provision of early intervention services have been monitored annually;
in fact the State had never monitored 32 municipalities at all.

The Self-Assessment identified, and State staff, local administrators,
and providers in all parts of the State confirmed, that the State's
monitoring system was only partially implemented from 1996-1999. During
that three year time period, NYDOH monitored New York City and 25 of the
participating 57 municipalities. NYDOH told OSEP that the remaining 32
municipalities that have never been monitored were scheduled to be
monitored during the 1999-2000 period.

State staff acknowledged that they were unable to implement an annual
monitoring schedule because of limited resources and the unanticipated
time needed to provide technical assistance to the local administrators
and providers as part of the monitoring activities. The lack of
effective monitoring procedures may have contributed to the areas of
noncompliance OSEP found, particularly in the provision of services in
natural environments and the identification and documentation of family
needs, concerns, priorities and resources on the IFSP, as further
described in this monitoring report.

The State recognized the need for additional assistance in the
implementation of its monitoring process and allocated funds in the
Federal Part C application for 1999 and subsequent years to contract for
the support and resources necessary to ensure that in subsequent years
all programs and agencies would be monitored on an annual basis.

**2. [Deficiencies Identified through Monitoring Not
Corrected]{.underline}**

States are required to adopt and use proper methods of administering the
early intervention program, including monitoring activities that will
identify deficiencies and provide for correction of those deficiencies.
34 CFR §303.501(b)(4). NYDOH must ensure that effective procedures are
in place to correct deficiencies and to implement the provisions of the
early intervention system consistent with Federal Part C regulations.
OSEP determined that NYDOH's procedures for corrective action do not
ensure the timely correction of deficiencies identified through its
monitoring activities.

NYDOH provided OSEP with monitoring materials used to monitor
participating programs and agencies. OSEP reviewed NYDOH's monitoring
protocols and reports for six municipalities and New York City. OSEP
visited five of these municipalities and New York City during the
validation data collection activities, and found that NYDOH had
identified several areas of noncompliance that OSEP identified in these
same municipalities. Some common areas included: (1) the lack of timely
evaluations; (2) IFSPs not completed within the 45 day timeline; (3) the
lack of family supports, assistive technology and respite services; (4)
IFSPs lacked a justification when services were not provided in the
natural environment; (5) transitions were not being conducted in a
timely manner; and (6) transition from Part C to Part B were not smooth
and timely. From 1996 to 1999, NYDOH identified noncompliance in New
York City and 25 municipalities, but approved corrective actions in only
10 of the municipalities. Although NYDOH's monitoring system identified
deficiencies, NYDOH does not have an effective mechanism to ensure
timely correction of the identified deficiencies.

The State's Self-Assessment and monitoring protocols indicate that
correction of identified deficiencies is assured by conducting follow-up
activities, including technical assistance with the programs. However
local administrators and providers stated that NYDOH has not provided
follow-up activities or the needed technical assistance to facilitate
compliance, and as a result, identified areas of noncompliance persist.
Local administrators statewide told OSEP that they needed technical
assistance in order to develop effective and appropriate corrective
actions in the areas of identified deficiencies. Local administrators
and providers informed OSEP that current corrective action procedures do
not include a mechanism to address the systemic nature of the identified
areas of noncompliance. Local administrators also reported that NYDOH
does not have a mechanism to inform local programs of noncompliance
issues in other regions, in order that they may contact those regions to
help identify corrective actions. They indicated that such a mechanism
would improve their own program. OSEP confirmed that the lack of
follow-up has contributed to ongoing noncompliance in the areas of
natural environments and transition, as indicated in the sections that
follow in this report.

**3. [Delays in the Provision of Technical Assistance to Programs and
Agencies]{.underline}**

The Part C regulations at 34 CFR §303.501(b)(3) require States to adopt
and use proper methods of administering each program including the
provision of technical assistance, if necessary. Technical assistance is
one technique that States can use to assist agencies and programs to
correct deficiencies identified through monitoring and to enforce any
obligations imposed on those agencies under Part C.

OSEP reviewed NYDOH's procedures for technical assistance and determined
that they were not effective to ensure that programs and agencies
receive timely and appropriate assistance. The lack of needed and
requested guidance may have contributed to the areas of noncompliance
described in Sections II through V of this monitoring report.

NYDOH as part of its general supervision activities requires each of the
57 municipalities and New York City to submit a 6-month progress report
that identifies administrative issues, a description of problems
encountered and technical assistance needs. OSEP reviewed the progress
reports, for the period of April 1998 through September1998, for each of
the municipalities visited and identified that requests for technical
assistance was indicated in all of the reports. Further analysis by OSEP
determined that requests for technical assistance was made in the
following areas: (1) procedures to determine the frequency and intensity
of early intervention services; (2) guidance to determine the need for
early intervention services such as respite, assistive technology, and
behavioral therapy; and (3) guidance to address the need for providers
to conduct evaluations and early intervention services.

In April 1999, OSEP found that follow-up activities, including the
provision of technical assistance to correct many of the areas of
concern as noted above by local administrators, service coordinators and
providers, was not timely, or had not occurred. OSEP was told by local
administrators, service coordinators and providers across the State that
they are unclear regarding the implementation of certain policies and
procedures in the provision of early intervention services. Local
administrators and service coordinators in all areas expressed the need
for more guidance and involvement of State Part C administers to clarify
issues such as: (1) coordinating child find provisions with the
Infant-Child Health Assessment Program and Maternal and Child Health
tracking program; (2) determining caseloads for service coordinators;
(3) parent choice versus the team decision-making process in determining
services; (4) procedures for obtaining approval for respite services;
(5) implementing Medicaid waiver provisions; (6) ensuring qualified
personnel for the provision of services; (7) the complaint process; and
(8) provisions for monitoring agencies and programs and providing timely
feedback.

Administrators and providers reported that if they contacted NYDOH for
clarification of an issue, the response from the State was not timely
and often resulted in delays in services to families and children. While
waiting for a response from the State, some local administrators and
providers reported that they would continue to implement the activities
or services without clarification in an effort to minimize any delay in
services for the child and family. However, later, without providing the
requested technical assistance, the State would send a letter citing the
program for a noncompliant practice. In all areas of the State OSEP
visited, administrators and providers reported that timely communication
and technical assistance are needed to ensure that locals are provided
the guidance they need to understand policies and implement the
requirements as set forth in State and Federal regulations.

The State, in its Self-Assessment, acknowledges the need to assess local
capacity in the provision of services and to provide guidance to local
administrators to ensure compliance with the provisions of Part C of
IDEA. OSEP will continue to work with NYDOH through the development of
improvement strategies, to ensure that the provision of technical
assistance results in better outcomes for children and families
throughout the State.

**4. [Failure to Issue a Written Decision on Complaints within the
60-Day Timeline and to Provide the Appropriate Follow-up Activities to
Ensure Compliance]{.underline}**

Consistent with 34 CFR §303.512 (a), States must issue a written
decision to the complainant that addresses each allegation in the
complaint within 60 calendar days. The lead agency may extend this
timeline if exceptional circumstances exist with regard to a particular
complaint.

OSEP found that NYDOH failed to investigate and render written decisions
within the required 60 calendar days. OSEP reviewed the State's
complaint procedures, including guidance for parents, *The Early
Intervention Program-A Parent's Guide,* that includes procedures on how
to file a complaint. OSEP determined that on its face, these documents
contain the appropriate procedures to meet Federal requirements. The
State's Self-Assessment indicated that since the State went into full
implementation in 1993, NYDOH has received and acted upon 165 Part C
complaints. OSEP reviewed the State's complaint log for the past three
years and noted that for 30 complaints NYDOH had not issued a written
decision within the required 60 calendar days. OSEP's review did not
identify information to indicate that time-lines had been extended as a
result of exceptional circumstances, nor was there information to
indicate whether there was a violation of Part C requirements or the
need for corrective action. NYDOH identified in the Self-Assessment that
of the 15 complaints received in FY 1998, none were resolved within the
required 60 calendar days; the State only sent letters within two
working days to acknowledge the receipt of the complaint. For these
complaints, the number of days exceeding the 60-day timeline ranged from
by a couple of days up to 120 days. NYDOH staff interviewed attributed
the backlog to shortage of personnel to handle the volume of complaints.

Providers and service coordinators statewide told OSEP that the State's
process for rendering a decision is not timely. Services providers and
service coordinators in three areas told OSEP that often a response from
the State takes four to six months. Therefore, the practice that is the
subject of the compliant, which may be noncompliant, continues (e.g.,
the decision-making process in the development of the IFSP to determine
the location for services) until the State issues a written decision.
Providers and coordinators in these three areas also told OSEP that the
State, instead of providing timely guidance to assist them in changing
the practice in question, will respond by sending a letter to the
program citing the program for implementing a noncompliant practice.
These providers and coordinators also reported that follow-up activities
were seldom provided in a timely manner, including technical assistance,
as described above in issue 3 of this section.

NYDOH must ensure that effective complaint procedures are in place to
assure the effective implementation of the lead agency's decision,
including technical assistance activities. 34 CFR §303.512 (b).

## C. SUGGESTIONS FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR FAMILIES

**1. [Assessing the Impact of Managed Care and Third Party Reimbursement
Procedures]{.underline}**

One of the required functions of the SICC is to assist the lead agency
in the effective implementation of the statewide system, by establishing
a process that includes: (1) seeking information from service providers,
service coordinators, parents, and others about any Federal, State or
local policies that impede timely service delivery, and (2) taking steps
to ensure that any policy problems identified are resolved. 34 CFR
§303.650(a)(3). The State must also ensure that Part C funds are not
used to satisfy a financial commitment for services that would otherwise
have been paid for from another public or private source. See 34 CFR
§303.527(a). These provisions require that Part C funds are used only
for early intervention services that are not currently covered under any
other Federal, State, local, or private source; and any policy issues
that have the potential to impede recommended services are resolved. The
potential problem areas listed below were identified by OSEP from the
data gleamed from the Self-Assessment, validation planning or data
collection process.

NYDOH must ensure that there are effective procedures in place to ensure
that evaluations, assessment and early intervention services are
administered consistent with Federal requirements and are not in any way
affected or diminished due to the funding or payor source (i.e. Part C
funds, managed care or any other source). Providers and local
administrators informed OSEP that current managed care guidelines
specify allotted amounts of time to perform evaluations and assessments,
indicate the frequency of early intervention services, and identify
allowable providers for services. Providers and local administrators
stated that guidance is needed to ensure that managed care guidelines do
not result in delays in the identification and evaluation of children
suspected of developmental delays and disabilities.

Local administrators and service coordinators also reported to OSEP that
current managed care policies requiring pre-approval for recommended
early intervention services may have a negative impact on the IFSP
decision making process. Providers and service coordinators told OSEP
that early intervention services covered under managed care are not as
readily accessible as services previously provided under the State
Medicaid system. Service coordinators reported that the managed care
approval process for evaluations and services is more time consuming and
may place an undue burden on service coordinators who already have
limited time to coordinate and negotiate the needed services for
eligible children and their families.

In addition, local providers and service coordinators told OSEP that
some private insurance companies have reduced or denied coverage for
early intervention services, since the enactment of Part C of IDEA.
These providers and service coordinators told OSEP that private
insurance companies have informed them that Part C Federal dollars are
the primary payor for early intervention services. Service coordinators
reported that the reimbursement process from insurance companies is not
timely. These service coordinators stated that the lack of timely
reimbursements places an undue burden on local resources. Administrators
told OSEP that it is becoming more difficult to subsume these costs with
limited local fiscal resources and service coordinators struggle to
balance recommendations for services with the availability of resources
to pay for them. The State must ensure that services needed by each
child and identified on the IFSP are provided in a timely manner, and
not delayed due to funding or reimbursement problems. 34 CFR
§§303.520(c), 303.527(b).

In addition, NYDOH in collaboration with the State Interagency
Coordinating Council may want to work with representatives from the
State agency governing health insurance and the Governor's office to
identify and address factors that may contribute to the denial and lack
of reimbursements for services by private insurance companies and the
reduction in services being imposed by managed care organization.

**2. [Coordination with other Federally Funded Programs Operating within
the State to Enhance Technical Assistance Efforts]{.underline}**

The identification and coordination of resources within the State,
including those from Federal, State, local, and private sources, is one
strategy NYDOH could use to enhance its efforts to ensure the provision
of technical assistance.

State staff, members of the State Interagency Coordinating Council,
providers and parents told OSEP that they were not always aware of other
programs or public or private initiatives that provide training and
information, conduct research, or develop demonstration models funded by
Federal or private sources. NYDOH may want to research sources within
the Federal Department of Education and Department of Health and Human
Services, to identify relevant programs and projects currently being
implemented by institutions of higher education, non-profit
organizations and public and private agencies that may be beneficial to
NYDOH in its ongoing technical assistance efforts across the State.

These programs and projects may identify promising practices and
strategies to foster collaboration across agency lines and enhance
existing resources and service provision. These programs may also be
beneficial to the State in the correction of identified deficiencies in
the areas of child find, personnel development, provision of services in
the natural environment, family centered practices, service
coordination, and the impact of managed care.

NYDOH, the State Interagency Coordinating Council, and steering
committee members may want to develop a process to identify, review and
incorporate ongoing research, personnel training, and demonstration
projects being implemented in the State in an effort to maximize
interagency and statewide technical assistance efforts.

# II. PART C: CHILD FIND/PUBLIC AWARENESS

The needs of infants and toddlers with disabilities and their families
are generally met through a variety of agencies. However, prior to the
enactment of Part C of IDEA, there was little coordination or
collaboration of service provision, and many families had difficulty
locating and obtaining needed services. Searching for resources placed a
great strain on families. With the passage of Part C in 1986, Congress
sought to assure that all children needing services would be identified,
evaluated, and served, especially those children who are typically
underrepresented, (e.g., minority, low-income, inner-city, Indian and
rural populations) through an interagency, coordinated,
multidisciplinary system of early intervention services.

Each State's early intervention system must include child find and
public awareness activities that are coordinated and collaborated with
all other child find efforts in the State. Part C recognizes the need
for early referral and short timelines for evaluation as development
occurs at a more rapid rate during the first three years of life than at
any other age. Early brain development research has demonstrated what
early interventionists have known for years, that children begin to
learn and develop from the moment of birth. Therefore, the facilitation
of early learning, and the provision of timely early intervention
services to infants and toddlers with disabilities is critical.

**[Validation Planning and Data Collection]{.underline}**

To facilitate the Validation Planning phase, OSEP reviewed several
documents that identify the State\'s efforts to locate and evaluate
potentially eligible children and their families. These documents
included, but were not limited to: the State's Self-Assessment, the Part
C application for fiscal years 1995-1998, the *Annual Performance
Reports* for *1994-1998,* the annual child count data, and relevant
child find and public awareness materials. OSEP also examined eight
discretionary projects, that OSEP awarded to New York. These
discretionary programs are designed to develop strategies to assist
States in the identification and evaluation of children with various
developmental delays.

During the Validation Data Collection phase, OSEP collected data from
local programs, providers, administrators and parents to investigate the
issues identified during validation planning, as stated above, and the
following issues: (1) the level of involvement and awareness about child
find in the medical community; (2) timeliness of, and age of children at
the time of, referral; and (3) effectiveness of child find efforts among
underrepresented groups. Analysis of the data collected resulted in the
identification of the following strengths, and suggestions for improved
results for infants, toddlers and their families.

## A. AREAS OF STRENGTH

**1. [Computerized Data System to Improve Child Find
Efforts]{.underline}**

NYDOH upgraded its computerized data system to improve ongoing State and
Federal initiatives to locate and identify potentially eligible
children. Current computerized data initiatives target linkages with
NYDOH's Infant Child Health Assessment Program, NYSED's preschool
special education student information system and the universal newborn
hearing screening program. By promoting data linkages with these and
other statewide data bases, NYDOH and the State Early Intervention
Coordinating Council anticipate that: (1) child find and public
awareness for Part B, Part C, and Maternal and Child Health will be
streamlined and more cost-effective; (2) gaps in the coordination of
resources to identify all potentially eligible children and their
families will be identified and addressed; and (3) transition of
children and families from hospital and high risk programs to Part C,
Part B and other appropriate community-based programs will be smooth and
timely.

**2. [Coordination of Resources to Enhance Child Find and Public
Awareness]{.underline}**

NYDOH has developed and distributed public awareness materials in a
variety of languages and formats to the general public and primary
referral sources. The State\'s Self-Assessment highlights some of the
accomplishments in this area. These accomplishments are in the following
areas: (1) development and dissemination of 200,000 public awareness
materials, *Early Help* brochures, and *Early Intervention Program: A
Parents Guide*; (2*)* development of an early intervention web page
linked to NYDOH\'s web-site; (3) operation of the Growing Up Healthy
Hotline; (4) development and dissemination of clinical practice
guidelines; (5) development of interagency agreements with the State
Department of Education and the Office of the Advocate for Persons with
Disabilities to facilitate the distribution of public awareness
materials, and the operation of a 1-800 number for information and
referrals; and (6) implementation of the *Training Together for Tots*
that provides information to primary referral sources including
physicians.

## 

## B. SUGGESTIONS FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR FAMILIES

**1. [Procedures to Ensure that all Potentially Eligible Children are
Identified, Especially Among Underrepresented Populations]{.underline}**

To address the growing need for strategies to ensure access to Part C
programs among underrepresented populations and to address areas of
concern identified in the validation planning and data collection
process, NYDOH instituted several initiatives. A primary initiative was
to expand child find efforts by entering into interagency agreements
with targeted agencies that serve this population, such as:
Developmental Disabilities Planning Council, Office of the Advocate for
Persons with Disabilities, and the Office of Alcoholism and Substance
Abuse Services. In addition, NYDOH developed partnerships with churches,
community agencies, ethnic radio stations and newspapers. The State has
provided culturally sensitive training activities such as *Training
Together for Tots* and *the Early Intervention Partners in Policy
Making* to encourage participation from underrepresented groups. NYDOH
has provided guidance and training to municipal officials and service
providers regarding the needs of multilingual families. Municipal
officials, to locate, select and train bilingual translators designed a
protocol and curriculum for use. A video, *Something Got Lost in the
Translation*, and training sessions on capacity-building for translation
services were also provided.

Although NYDOH has implemented several interagency and outreach
initiatives, as described above, these strategies have not fully
resolved the concerns relative to the timely identification and referral
of all potentially eligible children and families from underrepresented
groups as described below.

OSEP was informed by providers, parents and service coordinators across
the State, that although NYDOH is providing Part C services to 2.75 of
the 0-2 population, which is significantly above the national average,
there are potentially more eligible children that have not been
identified. Local administrators, service coordinators and providers
across the State told OSEP that the percentage of children in the Part C
system was not representative of the diverse cultural, socio-economic,
ethnic, and religious groups reflected in the general population in the
regions they serve. They further reported that these under-identified
groups include: indigent families, children of parents with disabilities
(particularly the deaf), those living in shelters, children of parents
known to the courts and the criminal justice system, those with mental
health issues, those living in public housing, those combating substance
abuse, physical abuse, children in the foster care system, and those
living on reservations geographically located within the State. The
State's Self-Assessment and Annual Child Count Report for FY 1998
indicated the need to enhance coordination efforts among agencies that
serve underrepresented groups.

Advocates and service providers, some of whom provide services in both
the early intervention and Part B preschool programs, told OSEP that too
many children with disabilities enrolling in preschool programs had not
been served by early intervention, and exhibit significant developmental
delays that could have been identified earlier if they had been referred
to the early intervention system.

The State's Self-Assessment and Child Count Data for FY 1998 also
indicated that although there has been a steady increase in the number
of referrals from the health care community, referrals from physicians,
visiting nurses, county health programs, and the Infant-Child Health
Assessment Program were relatively low even though some of these
programs are administered by NYDOH. The health community is critical in
ensuring access to services for underrepresented groups. Providers and
service coordinators confirmed the lack of efficient coordination among
these agencies, and stated that families do not receive the support they
need to access the Part C system.

Local administrators and providers across the State reported to OSEP
that while the State has embarked on several statewide child-find
initiatives to target these populations, there were impeding factors
that impacted on their effectiveness. Some of these factors include: (1)
the increasing number of culturally and ethnically diverse immigrant and
minority populations moving into and across the state; (2) lack of
culturally appropriate materials and services; (3) families' negative
perception of disabilities and developmental delays; and (4) the lack of
available resources. Providers and advocates confirmed to OSEP that
these factors challenge the State in its efforts to ensure access for
these families and their children to early intervention services. These
individuals reported to OSEP that NYDOH should design innovative and
effective strategies to ensure the participation of all agencies and
programs in the identification and referral of potentially eligible
children and their families.

State staff told OSEP that regional round-table forums were scheduled to
be held in various regions across the State to solicit information
regarding the barriers to child find, particularly among
underrepresented and under-served populations. The information will be
used to develop recommendations to enhance existing collaborative and
child find efforts in targeted communities across the State.

**2. [Procedures to Ensure Timely Referrals for
Evaluations]{.underline}**

OSEP reviewed NYDOH's Annual Child Count for FY 1998, and the data from
the State's Self-Assessment. The data indicate that while there has been
a significant increase in the number of children identified and referred
for an evaluation, the timely completion of evaluations is an area of
concern. Service providers and parents across the State told OSEP that
the medical community tends to have a "wait and see" attitude, and is
reluctant to refer children early for an evaluation, even when parents
express concern regarding their child's development, or in instances
when the child exhibited a physical delay.

Service coordinators and providers in three regions told OSEP that State
policy and procedures might contribute to delays in conducting
evaluations. They reported that State policy on child find stipulates
that referral sources must obtain parent consent before making a
referral to the Part C system. Previously, the State's policies and
procedures for child find required that referral sources obtain parent
consent before making a referral to the Part C system. NYDOH staff told
OSEP that this policy was revised in 1996 to be consistent with Federal
requirements (parents may refuse to consent to their child's evaluation,
but no affirmative consent is needed for referral). NYDOH has not been
effective in informing primary referral sources of this change.
Accordingly, many referral sources are continuing to delay referral
unless/until they can obtain parent consent. Service coordinators and
providers told OSEP that they were not aware of the change in policy,
and they were unaware that their practice was not consistent with
existing State policy.

These providers told OSEP that other State agency policies may also
contribute to the lack of timely referrals for evaluations. They
reported that policies related to foster care within the Department of
Social Services require the primary referring agency to obtain parental
consent before making a referral to the early intervention system,
resulting in delays in referrals for evaluations. Service coordinators
and providers confirmed that referrals for potentially eligible children
in the foster care system were delayed an average of 8-12 months.

New York should review its policies regarding referrals, to ensure that
primary referral sources are aware of those policies, and work with
relevant State agencies to improve the referral process.

# 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
include: (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 that 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 the 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 identified 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 would be found, so that
they will not be denied opportunities that all children have - to be
included in all aspects of our society. In 1991, Congress required that
early intervention services be provided in natural environments. This
requirement was further reinforced by the addition of a new requirement
in 1997 that early intervention could occur in a setting other than a
natural environment only when early intervention cannot be achieved
satisfactorily for the infant or toddler in a natural environment. In
the event that early intervention cannot be satisfactorily achieved 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]{.underline}**

The State's Self-Assessment identified several accomplishments and
concerns related to the provision of early intervention services in
natural environments. Some of these accomplishments included the: (1)
number of children receiving services in natural environments, including
child care settings (2) variety of service models to enhance better
outcomes for children and their families; (3) number of personnel
training programs implemented by institutions of higher education; and
(4) diverse strategies used to ascertain the effectiveness of the
State's system. A major concern identified as a result of the needs
assessment process was the need to develop a data-driven approach to
determining the capacity of the local service delivery systems across
municipalities and in New York City. In addition, NYDOH collaborated
with the Office of Children and Family Services to disseminate guidance
documents to local administrators regarding Medicaid billing and
ensuring the provision of service coordination through the Care-at-Home
and the Home and Community Based Waiver. These initiatives facilitate
support for ongoing service coordination and the provision of services
in a variety of natural environments by ensuring financial reimbursement
to localities and private providers.

OSEP reviewed the State's Self-Assessment, Annual Performance Reports,
Part C Application for FY 1998 funds, State and local contracts, IFSPs,
and other relevant documents, and after discussion with the Steering
Committee, the following areas were targeted for investigation during
the Validation Data Collection: (1) provision of timely services, (2)
continuous services for those children receiving services from local
education agencies, (3) services in the natural environment, (4)
adequate number of personnel, and (5) ongoing supports and services for
families.

To investigate Early Intervention Services in Natural Environments, OSEP
collected data from local programs, and providers in the early
intervention system, parents, and NYDOH State staff. Analysis of the
data resulted in the identification of the following strengths, areas of
non-compliance, and suggestion for improved results for infants,
toddlers and their families.

## A. AREAS OF STRENGTH

**1. [Child Care and Assistive Technology Initiatives]{.underline}**

According to NYDOH staff, State law provides support to the child care
community, including access to assistive technology to support the
integration of Part C-eligible children in community child care
settings. In addition, NYDOH engaged in interagency planning with the
New York State Child Care Coordinating Council and a variety of agencies
that resulted in the funding of 40 Child Care Resource and Referral
Agencies to implement activities to support early intervention service
delivery in family and child care homes, child care centers, and other
typical early childhood settings. As a result, the number of children
receiving services in childcare settings increased from 4.9% in 1993-94
to 6.49% in 1997-98.

NYDOH entered into an interagency agreement with the Office of the
Advocate for Persons with Disabilities to provide technology-related
assistance for families with children with disabilities. This assistance
promoted more independence among participating families and their
children and fostered greater involvement in community activities. NYDOH
has documented the success of these strategies by the increase in
services in natural environments from 60% in 1994-95 to 75% in 1997-98,
and as a result of child care initiatives and interagency agreements,
the increase in the number of authorizations for services in a variety
of service models across the State. Although there has been continued
progress in increasing options for services in a variety of settings,
children continue to be served in segregated center-based programs, as
noted in issue 2 of the noncompliance section below.

**2. [Development of Service Guidelines to Promote Individualized
Determinations]{.underline}**

NYDOH, recognizing the need for guidance and training to assist
providers and families in making informed decisions regarding service
practices, developed a series of clinical practice guidelines in the
areas of communication disorders and pervasive developmental disorders.
The guidelines are entitled: *The Report of the Recommendations, The
Quick Reference Guide, and The Guideline Technical Report*. These
guidelines highlight best practices, delineate research findings, and
are user-friendly and informative for both families and providers.

Development of these guidelines was an interdisciplinary effort by a
panel of developmental experts in the field of communication and a
project staff with extensive research and clinical practice experience.
The guidelines have proven to be a valuable reference tool for IFSP
teams making decisions regarding effective service delivery models that
reflect the individualized needs of the child and family. These
documents include recommendations to assist early intervention providers
to assess and provide intervention as needed for potentially eligible
children and their families.

**3. [Enhancing Local Capacity through Local Interagency Coordinating
Councils]{.underline}**

According to NYDOH officials, NYDOH established local early intervention
coordinating councils to collaborate with and advise early intervention
officials in the 57 municipalities and New York City regarding the
provision of services, inclusive of services in natural environments.
Local early intervention coordinating councils have been instrumental in
addressing issues regarding the timely referral of children in foster
care and initiating innovative service delivery models, such as the *Mom
and Me Programs*, to enhance opportunities for the services in natural
environments.

## B. AREAS OF NONCOMPLIANCE

**1. [Failure to Hold an IFSP Meeting within 45 Days]{.underline}**

Each early intervention system must ensure the performance of a timely,
comprehensive, multidisciplinary evaluation in each of the five
developmental domains. The initial evaluation, assessment and initial
IFSP meeting must be held within 45 days of referral. 34 CFR §§303.321
and 303.322.

NYDOH has not ensured that each child referred for evaluation receives a
timely multidisciplinary evaluation and assessment and that the IFSP
meeting is held within the required 45-day timeline.

OSEP reviewed NYDOH's monitoring reports, for the 1997 and 1998
monitoring period, for the six areas visited by OSEP. In the six areas,
OSEP found that NYDOH identified the failure of early intervention
programs: (1) to complete timely evaluations and assessments; (2) to
ensure that evaluations were completed in all required developmental
areas; (3) to ensure that evaluations and reports were completed and
available to conduct IFSP meetings. OSEP reviewed the active client
roster tracking form for December 1,1998, for each of the five
municipalities and New York City and determined that 169 of the 300
initial IFSPs still exceed the required 45-day timeline. Further
analysis by OSEP indicated that delays ranged from 46 days to one year
after the child and family were referred to the public agency. OSEP
reviewed the reasons for delays as indicated in the corrective action
plans submitted to the State; or as listed on the early intervention
services tracking form. Of the 169 IFSPs exceeding the 45-day timeline,
85 identified personnel issues, such as shortage of staff to conduct
evaluations, or the inability of service coordinators to schedule and
follow-up on evaluations and schedule IFSP meetings. Service
coordinators in four of the six areas visited told OSEP that due to
large caseloads and the lack of available evaluators they were unable to
complete the process within the 45 days.

In addition, administrative procedures, such as scheduling problems
resulting from the State's requirement for an early intervention
official to attend IFSPs meeting and review IFSPs, were also indicated.
Service coordinators and providers in three areas and local
administrators in one area told OSEP that development of initial or
periodic IFSPs are often delayed due to the inability of early
intervention officials to schedule to attend an IFSP meeting within the
45-day timeframe. The ability of the early intervention officials to
attend the IFSP meeting must not, in any way, delay conducting timely
IFSP meetings for the develop of the IFSP as required within 45 days.

**2. [Failure to Provide Services in Natural Environments]{.underline}**

Consistent with 34 CFR §303.344(d)(1)(ii), States must ensure that all
IFSPs identify the natural environments in which early intervention
services will be provided, and include a justification of the extent, if
any, to which the services will not be provided in a natural
environment. 34 CFR §303.18 defines natural environments as settings
that are natural or normal for the child's age peers who have no
disabilities. 34 CFR §303.12(b) requires that, to the maximum extent
appropriate to the needs of the child, early intervention services must
be provided in natural environments, including the home and community
settings in which children without disabilities participate.

As discussed below, NYDOH has not ensured that eligible children receive
all of the early intervention services needed, and that these services
are provided in natural environments. Further, NYDOH has not ensured
that IFSPs contain a justification if services will be provided in
settings other than a natural environment.

Providers and parents across the State informed OSEP that early
intervention services were frequently not provided in the child's
natural environment, and, of the 35 IFSPs reviewed by OSEP, 19 IFSPs
representing 3 of the 6 municipalities identified the provision of early
intervention services in an environment that did not meet the definition
for natural environment and further did not contain a justification.
Further review by OSEP indicated that services were being provided in
segregated early intervention classrooms, the office of service
providers or segregated preschool centers. Service providers reported to
OSEP several reasons for not providing services in natural environments.
These include a lack of providers, resulting in a waiting list for
vision services, occupational and physical therapy, and special
instruction services.

Service providers and service coordinators across the State told OSEP
that family \"choice,\" rather than the needs of the child, determines
where services are provided, and that many families choose to have
services provided in segregated center-based programs. OSEP was informed
by providers that the use of family \"choice\" is also driven by
Medicaid. Medicaid provisions require participating agencies to offer
families options to select eligible providers. However, early
intervention for an eligible infant or toddler can only occur in a
setting other than a natural environment when early intervention cannot
be achieved satisfactorily for the child in a natural environment. 34
CFR §303.167(c).

Further, the needs of the child and not family \"choice\" must be the
determining factor when making IFSP decisions. While the participants in
an IFSP meeting must carefully consider family preferences, family
"choice" does not diminish the responsibility of the IFSP team, as a
team, to develop the IFSP, including ensuring the provision of early
intervention services in natural environments. The service options
presented to families must meet the natural environment provisions,
unless there is a justification that can be documented on the IFSP that
warrants otherwise. Families must be presented with service options that
are consistent with Federal regulations, and not based on the
availability of services or the lack thereof.

Providers and parents informed OSEP that decisions about where services
are provided are based on available resources rather than on the
individual needs of the child and family. For example, when a provider
is also an employee of a local school system, the early intervention
services are only provided in a preschool classroom until the month of
June when school closes, and then they are provided in the home, if
another provider is available.

NYDOH must ensure that all children receive the early intervention
services they need in natural environments.

**3. [All Service Coordination Activities are not Provided to Families
]{.underline}**

States must ensure that all eligible children are assigned a service
coordinator upon referral to the Part C program. 34 CFR§§303.23,
303.321(e). Participating agencies and programs must ensure that service
coordination is an active, ongoing process that assists and enables an
eligible child and the child's' family to receive their rights,
procedural safeguards, and services. Service coordinators must be able
to effectively coordinate services across agency lines, serving as the
single point of contact in helping parents obtain the services and
assistance they need. 34 CFR §303.23.

NYDOH has not ensured that all families receive active, ongoing service
coordination. Providers and service coordinators across the State
informed OSEP that due to high caseloads, (the highest being around 500)
it is often not possible to carry out the necessary service coordination
activities. NYDOH's Annual Report indicated that the recommended
caseload for a full time service coordinator ranged from 35-60, far
below the numbers reported by service coordinators. Providers, parents,
and service coordinators reported that high caseloads resulted in
children not being referred for evaluations and assessments in a timely
manner and IFSP meetings not being held within the required 45-day
timeline, as described above in the areas of noncompliance, Finding 1.
Also, service coordinators are not coordinating family supports and
services as delineated in Section IV B of this monitoring report. NYDOH
confirmed the need to evaluate service coordinator caseloads and the
impact on the provision of services as part of the State's
Self-Assessment.

## C. SUGGESTION FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR FAMILIES

**[Improve Guidance on Respite Services and Assistive
Technology]{.underline}**

NYDOH's guidance document on respite, assistive technology services and
devices is unclear for many service coordinators and providers. Service
coordinators and parents across the State told OSEP that current
practice allows the participants in an IFSP meeting to recommend respite
services or assistive technology, but approval of the service,
frequency, intensity and allocation of cost is determined after the IFSP
meeting. Service coordinators and providers told OSEP that when a
family/individual is applying for respite services or assistive
technology funded by the Early Intervention Program, the early
intervention service coordinator completes an assessment form and
submits the request to the early intervention program director. The
program director approves the request for the service and indicates the
frequency and intensity of service to be provided. In the case of
assistive technology the early intervention director approves the type
of the device or equipment and the associated cost. This policy and
practice may be inconsistent with Federal requirements that the
participants in an IFSP meeting make individualized decisions for
services, and determine frequency of services.

In addition, State policy on the authorization for respite and assistive
technology might contribute to the delay and /or impede access to needed
services. Service coordinators and providers across the State informed
OSEP that there is a waiting list for respite services, and there is a
delay in obtaining approval for assistive technology devices or
equipment. Consistent with 34 CFR §303.344 (f)(1), the initiation of
services on the IFSP must be as soon as possible after the IFSP meeting.

NYDOH's Annual Performance Reports for the fiscal years 1994 to1997
indicated that authorization for respite services ranged from 90% in
only one county to less than 5% in 24 of the counties and only 1% for
assistive technology. Service coordinators and providers informed OSEP
that respite guidelines were unclear and the approval process was time
consuming. Respite services are not to be used in lieu of child-care,
but only when it is to meet the needs of the family related to enhancing
the child's development. However, it appears that in New York families
who are eligible or determined to need respite services are not
receiving the service.

The lack of access to assistive technology was also indicated as an area
of concern by providers and families. The State in the Annual
Performance Report for fiscal years 1994 to 1997 stated that they
believed that the failure of municipalities to utilize assistive
technology devices at an appropriate level is due to the failure of
NYDOH to finalize and disseminate appropriate guidance documents. The
Annual Performance Report identified that the development and
dissemination of appropriate guidance would be a priority of the State.

NYDOH may want to improve their guidance to providers and agencies to
ensure that eligible children and their families have timely access to
respite services, assistive technology and devices as appropriate.

# IV. PART C: FAMILY-CENTERED SYSTEM OF SERVICES

Research has shown that improved outcomes for young children are most
likely to occur when services are based on the premise that parents or
primary caregivers are the most important factors influencing a child's
development. Family-centered practices are those in which families are
involved in all aspects of the decision-making, families' culture and
values are respected, and families are provided with accurate and
sufficient information to be able to make informed decisions. A
family-centered approach keeps the focus on the developmental needs of
the child, while including family concerns and needs in the
decision-making process. Family-centered practices include establishing
trust and rapport with families, and helping families develop skills to
best meet their child's needs.

Parents and other family members are recognized as the linchpins of Part
C. As such, States must include parents as an integral part of
decision-making and service provision, from assessments, to the
development of the IFSP, through transition activities before their
child turns three. Parents bring a wealth of knowledge about their own
child and family's abilities and dreams for their future, as well as an
understanding of the community in which they live.

In 1986, Part C of the IDEA was recognized as the first piece of Federal
legislation to specifically focus attention on the needs of the family
related to enhancing the development of children with disabilities. In
enacting Part C, Congress acknowledged the need to support families and
enhance their capacity to meet the needs of their infants and toddlers
with disabilities. On the cutting edge of education legislation, Part C
challenged systems of care to focus on the family as the unit of
services, rather than the child. Viewing the child in the context of
her/his family and the family in the context of their community,
Congress created certain challenges for States as they designed and
implemented a family-centered system of services.

**[Validation Planning and Data Collection]{.underline}**

NYDOH identified several areas of concern in its Self-Assessment
regarding the need to improve access to family supports. Counseling and
training were identified as needs for families. To address issues
regarding culturally appropriate practices, the Self-Assessment
recommended sensitivity training for programs and agencies providing
services to culturally divergent families. OSEP also learned that the
State administers the *Promoting Community Membership* project that
includes a survey of parents of children who had an active IFSP as of
December 31, 1995. At the time of OSEP's visit the analysis of the data
showed that of the 28% of families that responded, most felt that they
were receiving the services that they needed. Families responding also
indicated that they were active in the planning of services, that
service coordinators were attentive to their concerns, and that overall
the family felt better as a result of participating in the Early
Intervention Program. In some areas of the State, Family Resource
Centers collaborate with local programs to provide needed supports and
services. Providers indicated that the present Early Intervention
Program is more family-driven. Various parent-training models were
identified, including the parent-infant program for the deaf that has
been effective in training parents and helping them support their
child's development.

During the Validation Planning and the Validation Data Collection
visits, parents, providers and administrators informed OSEP of the
following concerns: (1) need for parent training in different languages
and modalities to address needs of cultural and ethnic diversity, (2)
lack of support groups for immediate and extended family members, (3)
family supports and concerns need to be identified and addressed to
enhance access to services and (4) the need for development and
dissemination of culturally-relevant and family-friendly materials and
documents.

To investigate the concerns identified during the Validation Planning
process, OSEP collected information from the review of children's
records, State and local polices and procedures, and interviews with
NYDOH personnel, local program directors, service coordinators, and
parents. Information was also obtained from several of the Parent
Training and Information Centers.

OSEP reviewed and analyzed the data and identified the following
strengths and area of noncompliance.

## A. AREAS OF STRENGTH

**1. [Parent Guides to Enhance Awareness and Increase Participation in
the Early Intervention System]{.underline}**

NYDOH has made a concerted effort to reach out to families and get
information to them. An example of a family-centered strategy was the
development of a series of documents that included: *The Early
Intervention Program-A Parent\'s Guide*, *The Quick Reference Guide for
Parents and Professionals on Communication Disorders* and *The Quick
Reference Guide for Parents and Professionals on Autism/Pervasive
Developmental Disorders.* The State did a massive dissemination of
documents across the State.

The *Early Intervention Program Parent\'s Guide* informs families how
the Early Intervention Program works, defines frequently used
terminology, describes parents' rights, and provides the reader with a
list of phone numbers of programs and individuals who may assist them in
answering questions.

*The Quick Reference Guides* *on Communication and Pervasive
Developmental Disorders* were partially in response to the needs of the
growing numbers of children birth-to-three being identified whose
primary or secondary condition may manifest itself in communication
disorders, and/or pervasive developmental delays. *The Reference Guides*
were designed to assist families, professionals and public officials in
making informed choices about early intervention services by presenting
recommendations regarding diagnostic and intervention practices. During
the public input process OSEP was informed by parents and professionals
that these guides were useful in assisting parents to understand their
child\'s delay and in preparing parents to ask questions. Parents
reported that they felt more confident in participating in the Early
Intervention System.

**2. [Parent Involvement Subcommittee of State Early Intervention
Coordinating Council]{.underline}**

The State Early Intervention Coordinating Council has a parent
involvement subcommittee that has played a pivotal role in responding to
the concerns regarding family participation and involvement in the State
Early Intervention System. The committee proposed six activities to
ensure that meaningful family input occurred. These recommendations
included: (1) identifying promising practices for replication; (2)
planning and hosting family forums to solicit information; (3)
developing a family survey, (4) developing technical assistance
documents for local programs and agencies, (5) developing articles
concerning issues and promising practices for inclusion in the Focus on
Families newsletter, and (6) developing orientation materials for newly
identified State and local parent representatives.

## B. AREA OF NONCOMPLIANCE

**[Failure to Identify and Document Family Needs, Supports and Services
on the IFSP]{.underline}**

NYDOH must ensure the performance of a timely, comprehensive,
multidisciplinary evaluation of each child, birth through age two,
referred for an evaluation, and a family-directed identification of the
needs of each child\'s family to appropriately assist in the development
of the child. 34 CFR §303.322(a)(1). The family-directed assessment is
designed to determine the resources, priorities and concerns of the
family and to identify the supports and services necessary to enhance
the family's capacity to meet the developmental needs of their child. 34
CFR 303.322(d). The IFSP must include a statement of the major outcomes
expected for the child and family, as well as a statement of the
specific early intervention services necessary to meet the unique needs
of the child and family to achieve the outcomes, as determined by the
participants in the IFSP meeting. 34 CFR §303.344(c) and (d).

NYDOH has not ensured proper procedures to ensure that a voluntary
family-directed assessment is conducted for each family, to identify the
needs of the family and the supports and services necessary to enhance
the family's capacity to meet the developmental needs of the child.

OSEP reviewed 35 IFSPs and determined that 31 did not appropriately
document the identification of family resources, priorities and concerns
and supports to assist the family to enhance the development of the
child. The State's Annual Report for FY 1998 indicated that the
proportion of families authorized for family supports declined from 24%
in 1995-96 to 21% in 1996-97. Local administrators indicated that more
training is needed to adequately address the needs of the family and
document them on the IFSP. Some providers indicated that the assessment
of family supports and services is equivalent to a social history,
rather than an assessment of the needs leading to the identification of
needed services and supports. Families informed OSEP that more supports
and assistance are needed to identify needed resources and to network
with other families. Parents stated that they had to seek out resources
on their own and to act as their own coordinator. Families stated this
was stressful and they wished someone would have assisted them in
finding needed services and resources.

NYDOH recognized the need to investigate the area of family support and
services and has recommended that this issue be analyzed by the Parent
Involvement Subcommittee of the State Early Intervention Coordinating
Council. OSEP will continue to work with the State to ensure that any
recommendations resulting from the subcommittee's actions will result in
correction of the identified deficiencies.

# V. EARLY CHILDHOOD TRANSITION

Congress included provisions to assure that preschool or other
appropriate services would be provided to eligible children leaving
early intervention at age three. Transition is a multifaceted process to
prepare the child and the child's family to leave early intervention
services. Congress recognized the importance of coordination and
cooperation between the educational agency and the early intervention
system by requiring that a specific set of activities occur as part of a
transition plan. Transition activities typically include: (1)
identification of steps to be taken to prepare the child for changes in
service delivery and to help the child adjust to a new setting; (2)
preparation of the family (i.e., discussions, training, visitations);
and (3) determination of other programs and services for which a child
might be eligible. Transition planning for children who may be eligible
for Part B preschool services must include scheduling a meeting, with
approval of the family, with the lead agency, the educational agency and
the family, at least 90 days (with parental permission up to six months)
prior to the child's third birthday. Transition of children who are not
eligible for special education also includes making reasonable efforts
to convene a meeting to assist families in obtaining other appropriate
community-based services. For all Part C children, States must review
the child's program options for the period from the child's third
birthday through the remainder of the school year and must establish a
transition plan.

**[Validation Planning and Data Collection]{.underline}**

The State's Self-Assessment, Annual Report, and correspondence indicated
areas of strength and concerns. Local municipalities in some
jurisdictions were implementing a seamless birth-to-five system through
effective communication and coordination of services. Early Intervention
Officials were commended for participating in joint training with the
chairpersons of the preschool eligibility committee. OSEP reviewed the
Self Assessment and other data sources and, after interviews with local,
and State staff, providers and parents, determined that the following
areas of concern should be investigated: (1) documentation in IFSP
regarding transition planning, (2) identifying goals for the child to
adjust to the new environment, (3) timeliness of transition meetings,
(4) attendance of appropriate personnel at transition meetings, (5)
children and families remaining in Early Intervention Program even if
the child had been found eligible for Part B, due to a lack of space and
(6) need for family training.

To investigate the concerns identified during the Validation Planning
process, OSEP collected information from the review of children's
records and State and local polices and procedures, and interviews of
State personnel, local program directors, service coordinators, parents.

OSEP reviewed and analyzed the data and identified the following
strength and area of noncompliance.

## 

## A. AREA OF STRENGTH

**[Local Partnerships Enhance Transition Efforts]{.underline}**

NYDOH, in collaboration with the transition committee of the State
Interagency Coordinating Council, has implemented interagency training
for early intervention officials and chairpersons of the Committee on
Preschool Special Education across the State regarding provisions for
transition from Part C to Part B, and innovative partnerships have been
forged at the local level. Collaboration among local programs and
agencies to ensure a smooth transition process has been demonstrated in
some communities and may serve as model programs for other jurisdictions
in the State. Local interagency coordinating councils, early
intervention programs, local education agencies, early childhood
direction centers and community based programs, such as Head Start, have
formed local transition committees that include all the players in the
transition process. A parents' manual was developed that describes, in
user- friendly language, various roles and activities for parents and
outlines differences between the child's activities in the early
intervention environment and a typical day in a preschool program. As a
result, providers and parents told OSEP that a birth- to-five seamless
system of services for children and families has evolved in some
communities. School districts in some areas work in partnership with the
early intervention programs in their jurisdiction to schedule and
conduct Committee on Preschool Special Education meetings during the
summer months to minimize delays for families of children who turn 3
years of age during the summer.

## B. AREA OF NONCOMPLIANCE

**[Failure to Ensure Smooth and Effective Transitions]{.underline}**

The NYDOH must ensure that procedures are in place to ensure a smooth
and effective transition of eligible children and their families from
Part C to Part B preschool programs or other appropriate services by the
child's third birthday. In the case of a child who may be eligible for
preschool services under Part B of the Act, with the approval of the
child's family, a conference must be convened with the lead agency, the
family and the local education agency, at least 90 days before the
child's third birthday to discuss any services that the child may
receive and review the child's program options for the period from the
child's third birthday through the remainder of the school year. 34 CFR
§303.148(b)(2)(i). The lead agency must also ensure that procedures are
in place to ensure that the local educational agency for the area in
which the child resides is notified that the child will shortly reach
the age of eligibility for preschool services under Part B. 34 CFR
§303.148(b)(1). In addition if the Sate educational agency, which is
responsible for administering preschool programs under Part B of the
Act, is not the lead agency, under this part, an interagency agreement
between the two agencies to ensure coordination on transition matters.
34 CFR §303.148(c).

OSEP found that NYDOH has not ensured that a smooth and effective
transition is afforded eligible children and their families who
transition from Part C to Part B preschool and other appropriate
services by the child's third birthday.

As noted in the General Supervision section of this monitoring report,
NYDOH's corrective action procedures were not effective to ensure that
follow-up activities, inclusive of technical assistance was implemented
to correct identified areas of noncompliance relative to the transition
of children and their families from Part C to Part B preschool. OSEP
reviewed NYDOH's monitoring log for July 1998 and identified that in
three of six areas OSEP visited, the State had identified noncompliance
in the provision of transition services. NYDOH's monitoring reports in
these three areas also indicated the lack of coordination between the
lead agency staff and the local education agency, and the inability of
service coordinators to coordinate required transition activities for
children and families with local education agencies in a timely manner,
due to large caseloads as described in Section III of this monitoring
report.

NYDOH's policies and procedures specify that Part C funds may be used to
provide services to children from their third birthday to the beginning
of the following school year. Providers and parents told OSEP that
although this option was intended to ensure continuous services,
transition from Part C to Part B is often fragmented. Service
coordinators across the State told OSEP that children who turn three
during the summer months are given the option to remain in the Part C
program from September until January 1^st^. However, Part C funds can
only be used from the 3^rd^ birthday until the school year begins,
(i.e., September), and must be used to provide FAPE in accordance with
Part B. Providers reported that they were not always sure whether
parents who were given the option of remaining in Part C were adequately
informed of their rights. Specifically, providers told OSEP that they
were not sure that all children who turned three during the summer
months and remained in Part C had an IEP and were receiving FAPE
services. Parent and providers in three areas told OSEP that service
coordinators do not adequately plan transition activities with them.
Parents in three areas reported that families who chose to continue
their services in the Part C program may not transition in a timely
manner in January because the preschool program in their designated area
was often full by September, thus, families had to wait for preschool
services.

Parents also told OSEP that they did not fully understand the transition
process. Parents stated that transition is confusing, overwhelming and
they state that staff did not listen to them. Thus, they may be
reluctant to give consent to transfer records and to conduct
evaluations, when requested by service coordinators or local
administrators. This may contribute to the lack of timely transitions.

Administrators, service coordinators and providers reported that
transition is difficult because each school district has its own
policies and procedures, therefore service coordinators and local
administrators must be knowledgeable of the varied transition procedures
in order to correctly inform parents. Local school district
administrators do not always attend transition meetings as required and
do not delegate their responsibilities to a person who can make
decisions regarding transition activities, therefore the process is
delayed. In addition, some school districts close down during the summer
months; therefore transition plans are developed in the beginning of the
school year in September or October. As a result IEPs are not developed
in a timely manner and implemented by the child's 3^rd^ birthday. This
was confirmed by administrators, service providers, and parents.

OSEP's review of NYDOH's written policies and procedures regarding
transitions determined that they were adequate, and if implemented could
lead to smooth and timely transitions for eligible children and
toddlers, and correct the areas of noncompliance. NYDOH needs to
continue to work to eliminate the barriers as delineated above to
correct the areas of noncompliance.

[^1]: A medical home is an approach to providing health care services in
    a high-quality and cost-effective manner to children and their
    families in partnership with a pediatrician or physician. This
    approach is to ensure the identification and access to all medical
    and non-medical services needed to assist the child and family in
    achieving their maximum potential. American Academy of Pediatrics