a

GAO

United States Government Accountability Office

Report to the Ranking Minority Member, 

Committee on Health, Education, Labor, 

and Pensions, U.S. Senate

December 2005 INDIVIDUALS WITH 

DISABILITIES 

EDUCATION ACT

Education Should 

Provide Additional 

Guidance to Help 

States Smoothly 

Transition Children to 

Preschool

GAO-06-26
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

December 2005

INDIVIDUALS WITH DISABILITIES 

EDUCATION ACT 

Education Should Provide Additional 

Guidance to Help States Smoothly 

Transition Children to Preschool 

Highlights of GAO-06-26, a report to the 

Ranking Minority Member, Committee on 

Health, Education, Labor, and Pensions, 

U.S. Senate. 

Eligibility criteria for Part C services for infants and toddlers with disabilities 

differ from state to state, but do not consistently explain the percentage of 

children served, which ranges between 1.3 and 7.1 percent. To determine

eligibility, most states measure how much the child is delayed in one or more 

areas of early childhood development, while a few rely exclusively on a clinical 

team’s judgment. Although IDEA Part C is intended to cover children from birth 

to age 3, most states provide the majority of their Part C services to children 2 to 

3 years old. States have public awareness campaigns to identify more eligible 

infants and toddlers but cite a number of obstacles, including difficulty reaching 

children in rural areas or in families where English is a second language. 

The states we visited provide a similar set of services but vary in funding 

sources. States are required to make available certain early intervention services

under IDEA, such as occupational, physical, and speech therapy. However,

states report challenges recruiting and retaining professionals, such as speech 

language pathologists, to provide these services. States rely on various funding 

sources, but state general revenue funds were generally the largest source of 

early intervention funding. 

Percentage of Early Intervention Services Most Frequently Provided 

0 5 10 15 20

Family training, counseling,

and home visits

Occupational therapy

Physical therapy

Special instruction

Speech language therapy

Percentage of all services provided

Source: GAO analysis of the Department of Education’s 2002 IDEA data, IDEAdata.org.

Services

20

18

14

14

8

OSEP and state lead agencies have provided training and technical assistance

and used data to monitor implementation of IDEA Part C, but OSEP has lacked 

some information from local officials needed to determine if children are 

smoothly transitioning from Part C to Part B. OSEP uses annual reports and 

performance indicators as part of its effort to monitor compliance with Part C 

and target technical assistance. For example, data on the percentage of children 

served help inform OSEP of states’ efforts to identify all eligible children. States 

use similar approaches. Despite these activities, state officials cited challenges

transitioning children to Part B services when they turn 3 years old. Education

indicated that in preliminary and unpublished data from an ongoing study it had 

found that gaps occur throughout the year. Officials in the states we visited 

reported that some children who turn 3 during the summer experience gaps in 

service. If Part B eligibility is not determined prior to children turning 3 during 

the summer, then subsequent decisions about whether children should receive 

extended school year services cannot be made. 

Part C of the Individuals with 

Disabilities Education Act (IDEA) 

was established to ensure that 

infants and toddlers with

disabilities, from birth to age 3, and 

their families receive appropriate

early intervention services. Within 

the Department of Education 

(Education), the Office of Special 

Education Programs (OSEP) is 

responsible for awarding and 

monitoring grants to states for Part

C according to IDEA requirements. 

To address questions about how 

states have implemented IDEA Part

C, this report provides information 

on (1) how Part C programs differ

in their eligibility criteria and 

whom they serve, (2) to what 

extent states differ in their 

provision of services and funding, 

and (3) how Education and state 

lead agencies help support and

oversee efforts to implement Part 

C, such as identifying children for 

services and transitioning children 

to follow-on programs, such as

IDEA Part B. 

What GAO Recommends

GAO recommends that Education 

provide states with additional 

guidance on transition planning 

and services, especially for 

children who would enter Part B 

during the summer. In comments 

on our draft, Education cited an

ongoing study of general transition 

issues. When Education verifies the

results of its study, it should use 

that information to inform

guidance to states on transition 

planning. 

www.gao.gov/cgi-bin/getrpt?GAO-06-26.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marnie Shaul at 

(202) 512-7215, or shaulm@gao.gov. 
Contents 

Letter 1

Results in Brief 4

Background 7

Eligibility Criteria Differ among States but Are Not Consistently 

Related to Percentage of Children Served 11 

Selected States Provide Similar Services but Vary in Funding 

Sources 15

Both OSEP and States Use Data to Monitor Part C Compliance, but 

Challenges Persist in Transitioning Children to Part B 22 

Conclusions 29

Recommendations for Executive Action 30 

Agency Comments and Our Evaluation 30 

Appendix I Select Federal and State Funding Sources for Early 

Intervention Services 32 

Appendix II Comments from the Department of Education 34 

Appendix III GAO Contact and Staff Acknowledgments 36 

Table 

Table 1: Sources of Funding for Early Intervention Services in Site 

Visit States 20 

Figures 

Figure 1: States Visited with Type of Agency Leading Part C and 

Number and Percentage of 0-3 Population Participating in 

Part C 3 

Figure 2: Stages of a State Early Intervention System from Intake to 

Service Delivery 10 

Figure 3: National Percentage of Children Receiving IDEA Services 

by Age in 2004 14 

Figure 4: Examples of Services States Made Available to Infants 

and Toddlers Covered by Part C 16 

Page i GAO-06-26 Individuals with Disabilities Education Act
Figure 5: Percentage of Early Intervention Services Most 

Frequently Provided 17 

Figure 6: Examples of Federal and State Funding Sources 19 

Abbreviations 

CDC Centers for Disease Control and Prevention 

IDEA Individuals with Disabilities Education Act 

IEP individualized education program 

LEA local education agency 

NEILS National Early Intervention Longitudinal Study 

OSEP Office of Special Education Programs 

TANF Temporary Assistance for Needy Families 

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Page ii GAO-06-26 Individuals with Disabilities Education Act
United States Government Accountability Office

Washington, DC 20548 

 

December 14, 2005 

The Honorable Edward M. Kennedy 

Ranking Minority Member 

Committee on Health, Education, Labor, and Pensions 

United States Senate 

Dear Senator Kennedy: 

The first few years of a child’s life are critical to development. While most 

children attain developmental milestones as expected, some children 

develop more slowly or develop differently because of physical, mental, or 

environmental factors. Research suggests that for an infant or toddler who 

exhibits developmental delay, has a diagnosed condition that has a high 

probability of resulting in developmental delay, or is substantially at risk 

of having a developmental delay early intervention services, such as family 

counseling and physical therapy, can have a significant impact on early 

childhood development. To assist states in ensuring that such infants and 

toddlers receive early intervention services and support, Congress 

appropriated $444 million in fiscal year 2004 for grants to states under Part

C of the Individuals with Disabilities Education Act (IDEA Part C). States 

used Part C grants to arrange early intervention services for approximately 

279,000 infants and toddlers with disabilities from birth to age 3.

Administered by the Department of Education’s (Education) Office of 

Special Education Programs (OSEP), Part C is intended to support states’ 

efforts to coordinate and leverage funding from other federal, private, 

state, and local sources to ensure early intervention services are available

to eligible children. For services to children with disabilities after their 

third birthday, IDEA Part B Section 619 provides grants to states to 

provide special education and related services to children with disabilities 

aged 3 through 5 and, at a state’s discretion, to children before their third 

birthday.

Given your interest in the manner in which states have implemented the 

provisions of Part C, we examined (1) how Part C programs differ in their 

eligibility criteria and whom they serve, (2) to what extent states differ in 

their provision of services and funding, and (3) how Education and state 

lead agencies help support and oversee efforts to implement Part C, such 

as identifying children for services and transitioning children to IDEA Part 

B or other services. 

Page 1 GAO-06-26 Individuals with Disabilities Education Act
We used multiple data collection methods to address these issues. We 

conducted site visits to seven states—Colorado, Hawaii, Illinois, Maryland, 

Massachusetts, New Jersey, and Oregon—and reviewed their annual 

performance reports. We chose states to visit based on the type of state 

agency responsible for coordinating the Part C program (lead agency), 

number of children served, whether the state served at-risk children, 

geographic location, and whether the state participated in an OSEP-funded 

project aimed at early identification of infants and toddlers. Figure 1 

illustrates the states visited and selected characteristics. 

Page 2 GAO-06-26 Individuals with Disabilities Education Act
Figure 1: States Visited with Type of Agency Leading Part C and Number and Percentage of 0-3 Population Participating in

Part C 

Maryland

Education Lead

6,276 children served

2.8 % of the population

New Jersey

Health lead

7,790 children served

Illinois 2.2 % of the population

Human services lead

15,318 children served

2.9% of the population

Hawaii

Health lead

3,936 children served

7.1 % of the population

Massachusetts

Health lead

13,757 children served

5.8 % of the population

Colorado

Education lead

3,484 children served

1.7 % of the population

Oregon

Education lead

2,081 children served

1.6 % of the population

Site visit states

Source: GAO analysis of the Department of Education’s 2004 IDEA data, IDEAdata.org, and Office of Special Education Programs.

Note: Hawaii and Massachusetts serve at-risk children. 

Page 3 GAO-06-26 Individuals with Disabilities Education Act
In each of the selected sites, we met with state Part C coordinators, states’ 

Part B staff responsible for transitioning children to preschool programs, 

and the manager of one or more local early intervention programs. 

Because Medicaid—the federal-state health-financing program for certain 

low-income individuals—can be an important source of funds for early 

intervention services for Medicaid-eligible children, we also met with 

Medicaid officials in three states. Additionally, we met with OSEP officials 

and reviewed their guidance and monitoring reports. We also analyzed

2002, 2003, and 2004 data collected by Education. We used the most recent 

data available from OSEP. These data, available at IDEAdata.org, include

information about infants and toddlers with disabilities, such as the 

services they received, the location where they received them, and what 

follow-on program they entered when they were no longer eligible for Part

C. We used information from IDEAdata.org for the 50 states and the 

District of Columbia. Although we determined that some data provided by 

OSEP were not reliable, we obtained documents demonstrating that the 

office has controls in place to ensure a reasonable degree of accuracy and 

reliability in many of its data, and determined that the data elements we 

used were sufficiently reliable for our purposes. We also conducted 

interviews with educational associations, officials from the Centers for 

Disease Control and Prevention’s National Center on Birth Defects and 

Developmental Disabilities, and other experts. Our work involved 

reviewing the availability and differences in types of services; we did not 

examine the quality of services delivered or the appropriateness of 

services provided to children. We conducted our work in accordance with 

generally accepted government auditing standards between September 

2004 and December 2005.

Nationwide, states’ eligibility criteria for Part C services differ, but are not 

consistently related to the percentage of children served. State eligibility 

requirements vary for children who do not have an established or 

diagnosed condition that has a high probability of resulting in

developmental delay. Most states require that such children exhibit a 

specific level of developmental delay and be deemed eligible according to

an informed clinical opinion. A few states rely exclusively on clinical 

judgment. For example, Arizona requires 50 percent delay in one or more 

aspects of development, such as physical or emotional, while Hawaii relies 

on the judgment of a team of clinicians. Moreover, eight states also include 

in their eligibility criteria infants and toddlers who are at risk of having a 

substantial developmental delay because of biological risks, such as low 

birth weight, or environmental risks, such as parental substance abuse. 

However, eligibility criteria do not sufficiently explain differences in the 

Results in Brief 

Page 4 GAO-06-26 Individuals with Disabilities Education Act
percentage of all infants and toddlers in a state receiving early intervention

services. The Centers for Disease Control and Prevention (CDC) reported 

a lack of data on the prevalence in the general population of children 

under 3 who have developmental delays and could benefit from early 

intervention services; many conditions covered by the Part C eligibility 

definitions—such as learning disabilities or emotional disorders—are not 

routinely tracked. Although IDEA Part C is intended to cover children 

from birth to age 3, most states (38) provide the majority of their Part C 

services to children 2 to 3 years old. States have developed public 

awareness campaigns to help identify more infants and toddlers in need of

services, but officials in the states we visited told us that a number of 

obstacles prevented them from reaching all children as early as possible, 

including difficulty in reaching children in families where English is a 

second language or families living in rural areas. 

The states we visited provided similar services and confronted similar 

challenges recruiting and retaining staff to deliver them, but they varied in

funding sources. States are required to provide certain services to children

in early intervention programs, including occupational, physical, and 

speech language therapy to help with skills like feeding, walking, and 

talking. However, states reported challenges recruiting and retaining 

individuals to provide these services, especially speech language 

pathologists and occupational therapists. State officials noted that 

providers often have to spend time traveling to the homes of families to 

deliver services, which they said could be burdensome, and they also 

noted salaries are often higher in the private health care sector. States use 

various sources of funding to support Part C services, with some relying 

on multiple funding sources and others relying primarily on Part C and 

state general revenue funds. State general revenue funds constituted the 

largest source of early intervention funding in most of the states we 

visited, while local funds were often a much smaller source. Officials in 

the states we visited said there were challenges in accessing some funding 

sources, such as Medicaid. We found inconsistencies in the funding data 

states provided to OSEP as part of their annual performance reports, and 

OSEP decided during our review that the data were incomplete and 

unreliable and announced plans to stop collecting them. 

OSEP and state lead agencies provide training and technical assistance 

and use data to monitor implementation of IDEA Part C, but they have 

lacked some information needed from local service providers to determine 

if children are smoothly transitioning from Part C to Part B. To monitor 

states’ compliance with Part C requirements and to target technical 

assistance, OSEP examines annual performance reports, performance 

Page 5 GAO-06-26 Individuals with Disabilities Education Act
indicators, and other data provided by state lead agencies. States, which 

are responsible for oversight of local programs, are free to design their 

own oversight methods, but they generally described approaches similar 

to OSEP’s. Despite oversight and assistance activities, state and local 

officials in the states we visited cited challenges in transitioning children 

to Part B services when they turn 3 years old. In addition, in commenting 

on a draft of this report, Education cited preliminary unpublished data that 

would suggest transitions are a year-round problem. Officials in the states 

we visited reported that some children who turn 3 during the summer 

experience gaps in service during the transition process. The gaps occur,

in part, because school districts generally operate on a 9-month academic 

calendar and some school districts may delay determination of eligibility 

for any Part B services until the fall. If Part B eligibility is not determined 

prior to children turning 3 during the summer months, then subsequent 

decisions regarding extended school year services cannot be made. Most 

officials said the frequency with which extended school year services are 

provided to children transitioning to Part B could not be determined 

because neither OSEP nor the state collected extended school year data.

Also, Part C officials and local early intervention staff told us they face

difficulties in finding out if children are determined eligible for Part B. Not 

having eligibility information hinders local early intervention staff’s timely 

referral of children found ineligible for Part B to other follow-on preschool 

programs. Additionally, Part C officials are responsible for reporting Part

B eligibility to OSEP. 

In its comments on a draft of this report, Education disagreed with our 

recommendation that it incorporate into its research agenda a method for 

determining how frequently children transitioning from Part C to Part B do 

not receive services during the summer months. Education noted that 

preliminary and unpublished data from a department study indicate that 

gaps occur when children are transitioned from Part C to Part B, not only 

during the summer, but whenever transitions occur. Additionally, in 

response to our recommendation that if gaps in services are found to be a 

problem, Education should provide states with additional guidance on

improving children’s access to extended school year services, Education 

stated that, based on its preliminary data, there is no need to study 

extended school year services. We modified our recommendation to 

acknowledge Education’s ongoing study and are now recommending that 

the Secretary of Education provide states with additional guidance on

transition planning and services for children with birthdays during the 

summer and especially in cases where children are likely to need extended 

school year services. Additionally, when Education completes and verifies 

Page 6 GAO-06-26 Individuals with Disabilities Education Act
the results from its ongoing studies relating to transitioning, it should use 

that information to inform the department’s guidance on transitioning. 

According to research, comprehensive early intervention programs can 

positively affect the progress of children with developmental delays and

children at risk of having a disability. Services provided by these programs 

may include speech language therapy, family counseling, and home visits. 

Research has linked early intervention services to improvements in 

toddlers’ behavior, interactions between parents and children, infant 

development, and overall quality of life for children and their families. 

Additionally, research has found increased mental development and better 

vocabulary and reasoning skills for children who received early 

intervention services when compared with those who did not receive

these services. Findings from the National Early Intervention Longitudinal

Study (NEILS), a research project sponsored by the Department of 

Education, has found that parents report a high degree of satisfaction after 

receiving 3 years of early intervention services, reporting that their 

families are better off and that early intervention services are having “a 

lot” of impact on their child’s development.1

Background 

IDEA is the primary federal education law for infants, toddlers, children, 

and youth with disabilities. Grants to states for early intervention services 

and special education and related services for children with disabilities 

and their families are provided mainly through Parts C and B of the act. 

These parts have different histories and are generally administered by 

different agencies at the state level. IDEA Part C was established to ensure

that infants and toddlers, from birth to age 3, with disabilities or at risk of 

developing a disability, and their families receive appropriate early 

intervention services. Part C focuses on, among other things, enhancing 

the development of infants and toddlers with disabilities by providing 

services in a natural environment, such as the home or a child care center. 

This part of the law seeks to improve the capacity of the family to meet the 

child’s needs and reduce educational costs by minimizing the need for 

special education when the child is older. Part B, in contrast, requires that 

 1

NEILS is tracking the outcomes of over 3,300 infants and toddlers with disabilities and 

those at risk of a disability and their families. The study tracks children starting from their 

experiences in early intervention to early elementary school and will provide outcome data

on children and families receiving early intervention and how these outcomes relate to 

child and family characteristics and the types of services provided. The grant for the study 

ends in 2005 and the final report is anticipated to be available in 2006. 

Page 7 GAO-06-26 Individuals with Disabilities Education Act
services, to the extent possible, be provided in educational settings, such 

as regular classrooms. Part B, which includes state grants for children and

young adults ages 3 through 21, and Part B Section 619 preschool grants 

for children 3 through 5, aims to ensure that children with disabilities have 

access to a free appropriate public education. Funding for Part B is 

significantly larger than for Part C programs. In fiscal year 2004, Part C 

was funded at $444 million, and approximately 279,000 infants and 

toddlers received services.2

 In contrast, Part B state grants and the Section 

619 supplement for preschool services were funded at $10 billion and $388 

million, respectively, in 2004. Approximately 6 million children were 

provided services under Part B state grants, and over 693,000 children 

were provided preschool services under Part B Section 619. 

To meet Part C goals, states use funds to develop a statewide, coordinated,

multidisciplinary, interagency system of early intervention services for 

infants and toddlers with disabilities and their families. Developing such a 

system includes designating a lead agency, preparation and dissemination 

of materials on the availability of services, defining eligibility criteria, and 

delivering services. To this end, each state has a designated lead agency

responsible for the administration, supervision, and monitoring of Part C.

In contrast to Part B, which is led by state education departments, Part C 

is led by the health department in 16 states, education departments in 11 

states, and other departments, including combined health and human 

services departments, in the remaining 23 states. States are expected to

leverage funding, services, and resources from other sources to provide 

early intervention services. Each state must have a continuous process of 

public awareness activities and evaluations designed to identify and refer 

as early as possible all young children with disabilities and their families 

who are in need of early intervention services. By law, public awareness 

efforts should include disseminating information to parents on available 

early intervention services and to all primary referral sources, especially

hospitals and physicians. Efforts may also include television ads, 

pamphlets, and posters describing IDEA Part C and how parents can 

access services for their child. 

Once a child is referred and suspected of having a disability, states are 

required to conduct an evaluation to determine if the child meets the 

state’s eligibility criteria. In order to be eligible for federal funds under 

Part C, IDEA requires that states provide services to any child under 3 

 2

Part C was appropriated $441 million for fiscal year 2005. 

Page 8 GAO-06-26 Individuals with Disabilities Education Act
years of age who is developmentally delayed. These delays must be 

measured by appropriate diagnostic instruments and procedures or 

validated by professional opinion, and may occur in one or more of the 

areas of development—including cognitive, physical, communicative,

social or emotional development, and adaptive behavior, such as feeding

or toileting. States must also provide services to those children that have a 

diagnosed mental or physical condition that has a high probability of 

resulting in developmental delay. However, states are free to define what 

constitutes a developmental delay and specify how this will be measured. 

In addition, states may choose to serve children who are at risk of having a 

substantial developmental delay. These may include biological risks, such 

as low birth weight, and environmental risks, such as parental substance 

abuse. Once an eligible delay has been detected, service coordinators 

work with parents and others to match children with services specific to 

their needs. Part C requires that every state make certain services 

available, including special therapies such as physical, occupational, or 

speech language therapy, and family supports such as home visits. For 

example, an occupational therapist may come to a child’s home to teach a 

child to draw, which involves hand and eye coordination. The law also 

requires that services be provided in children’s natural environments. 

Figure 2 illustrates the typical process in early intervention programs. 

Page 9 GAO-06-26 Individuals with Disabilities Education Act
Figure 2: Stages of a State Early Intervention System from Intake to Service Delivery 

Family doctor, 

child care center,

or parent suspects

a developmental delay

0-3 years old

Child 

is

evaluated

Given designated 

service 

coordinator

Coordinator develops

individual family service plan

Outlines services for 

 Physical therapy

 Speech therapy

 Occupational therapy

 Other

Meeting held to determine what 

happens when child 

becomes 3 years old

Before a child

is 2 years 

9 months old

 Special education 

in preschool

(Part B)

 Other 

community 

program

No 

services 

needed

1. Referral 2. Identification 3. Evaluation

5. Transition

6.

Source: GAO analysis of IDEA Part C legislation.

 Office receives

 referral from

 concerned 

 adult

4. Service coordination

If evaluation 

confirms a delay

If Part B

 eligible 

If not Part B eligible

?

Children eligible for Part C can receive early intervention services until 

they turn 3 years of age. Part C funds can be used to provide services to 

children from their third birthday to the beginning of the following school 

year, but as of 2004 only 14 states have adopted such a policy. Thirty states 

allow for the use of Section 619 preschool funds to provide services to 

children before their third birthday. As a child approaches age 3, the local 

education agency (LEA) determines the child’s eligibility for Part B 

Section 619 preschool services. If eligible for Part B Section 619, the child 

might also be eligible for extended school year services. An extended 

Page 10 GAO-06-26 Individuals with Disabilities Education Act
school year ensures that a child can continue receiving services even when 

schools are not in session, for example, during the summer. According to 

Education, most children under Part B do not receive extended school 

year services. By contrast, Part C is a year-round program. Eligibility for 

an extended school year is determined on an individual basis and is 

generally based on how much a child will regress and the time it will take 

to regain lost skills. During the most recent reauthorization of IDEA, in 

2004, Congress gave states the option of allowing children to continue to 

receive services under Part C until they become eligible for kindergarten.

States vary in both the criteria used to establish eligibility for services and 

the means used to assess whether children fit these criteria, but these 

differences are not consistently related to the percentage of children 

receiving early intervention services. While Part C is intended to serve 

infants and toddlers from birth to age 3, the majority of children receiving 

services nationwide and in most states are toddlers between ages 2 and 3.

Officials in states we visited told us that despite their various public 

awareness efforts, there are a number of challenges in identifying all

children eligible for services, specifically reaching children whose families 

speak limited English or live in rural areas. Comprehensive data on the 

number of children who could benefit from early intervention are not 

available; many conditions covered by Part C—such as emotional 

disorders and learning disabilities—are not systematically tracked. 

Nationwide, states’ eligibility criteria for Part C services vary, with most 

states specifying the amount of delay in development a child must 

experience to be eligible for services, while a few rely exclusively on the 

judgment of a multidisciplinary clinical team. IDEA generally gives states

the discretion to determine specific eligibility criteria and diagnostic 

procedures. For example, Part C specifies that a child have an established 

condition that has a high probability of resulting in a developmental delay, 

or that a delay is present in one or more areas of development—cognitive,

physical, communicative, social or emotional, or adaptive—and that all 

states allow for the use of informed clinical opinion in their evaluation.

However, states can determine the amount of delay a child must 

experience in order to be eligible for services. Part C also gives states 

discretion to identify the appropriate diagnostic instruments to measure 

the extent of a child’s delay or to rely exclusively on the informed opinion 

of professionals. For example, Arizona requires a 50 percent delay in one

or more aspects of early childhood development, such as physical or 

emotional development. New Jersey’s eligibility criteria vary depending on

Eligibility Criteria 

Differ among States 

but Are Not 

Consistently Related 

to Percentage of 

Children Served 

States Have Different 

Eligibility Criteria and 

Means of Assessing 

Developmental Delay 

Page 11 GAO-06-26 Individuals with Disabilities Education Act
the number of areas in which a child is developmentally delayed. The state 

requires that children have a 33 percent delay in one area of development, 

but a 25 percent delay in two or more areas of development. The Centers 

for Disease Control and Prevention noted that the significance and 

implication of a given percentage delay vary across areas of development.

For instance, according to CDC, a 25 percent delay in motor skills 

development has much different implications for services for a child than

a 25 percent delay in language development. Other states’ eligibility 

criteria are based on the number of months or standard deviations from 

age norms. For example, in Massachusetts, a 24-month-old child 

functioning at an 18-month-old level could be eligible for services. In 

Georgia, a child whose cognitive abilities are at least two standard 

deviations less than the abilities of most children at the same age would be

eligible for services. Hawaii does not specify a percentage delay and 

instead relies on the judgment of a multidisciplinary team, which generally 

includes either a speech therapist or special educator and an occupational 

or physical therapist. Despite wide variation in how states define 

eligibility, variation among states in the percentage of children served is 

not consistently explained by eligibility criteria. For example, Alabama, 

which has broad eligibility criteria (25 percent delay in one or more areas) 

served only 1.3 percent of infants and toddlers in 2004, while North 

Dakota, which has stricter eligibility criteria (50 percent delay in one area, 

25 percent delay in two or more areas, informed clinical opinion), served

2.8 percent of its infants and toddlers. In 2004 the percentage of children

served from state to state ranged between 1.3 and 7.1 percent. 

Although not required by Part C, as of March 2005, 8 states—California, 

Hawaii, Indiana, Massachusetts, New Hampshire, New Mexico, North 

Carolina, and West Virginia—also served children at risk of having a 

substantial developmental delay. For example, in Hawaii, children from 

families where child abuse or neglect is present may qualify for services. 

In Massachusetts, children born with low birth weight or chronic lung 

disease may qualify for services. States that we visited that do not serve atrisk children—Colorado, Illinois, Maryland, New Jersey, and Oregon— 

expressed interest in serving them but told us that the additional costs 

associated with increasing the number of eligible children prevented them

from doing so. Instead of providing services to at-risk infants and toddlers 

under IDEA Part C, some states track at-risk children or provide services 

to them through other programs. For instance, in Ohio, children at risk are 

served through a statewide program, funded in part by federal dollars, 

known as Ohio Early Start. Through this program, they receive services 

similar to those children receive under Part C. 

Page 12 GAO-06-26 Individuals with Disabilities Education Act
While Part C funding is intended to serve infants and toddlers from birth to 

age 3, the majority of children receiving services are toddlers between 

ages 2 and 3. In 2004, infants, children under the age of 1, constituted only 

14 percent of the approximately 279,000 children served nationwide, and 2 

to 3-year-olds accounted for 54 percent. Likewise, in 38 states, the majority 

of children served were 2 to 3-year-olds. In Maryland and Illinois, 2 to 3-

year-olds made up 54 percent and 55 percent of the children served, 

respectively. OSEP and state officials told us that a majority of children 

enter the Part C system after age 2 because this is the age at which speech 

language delays become apparent and indicated that such deficiencies are

not easily detected in younger children. According to Education officials, 

difficulty detecting deficiencies in younger children is due to numerous 

factors, including difficulties in assessment, pediatrician or parent “wait 

and see” attitudes, and lack of parental consent. Children who enter the 

Part C program in infancy are generally those diagnosed at birth with 

conditions such as chromosomal abnormalities and genetic or congenital 

disorders. 

Majority of Children 

Served under Part C Are 

between Ages 2 and 3 

It also appears that many children are eventually identified as needing 

services when they become older. Part B Section 619, which serves 

children ages 3 through 5 years, serves many more children than Part C, as 

shown in figure 3. In 2004, Section 619 served over 693,000 children, 

compared with approximately 279,000 children under Part C, and this 

pattern is mirrored in most states. This may be attributable to a variety of 

factors. Some delays become more apparent as children get older. 

Developmental delays are also more likely to be detected once a child 

enters a group setting, such as a preschool or kindergarten program, when 

comparison with peers may highlight some delays. Additionally, some 

parents may turn to private insurance to pay for services during the first 

few years of a child’s life, and enter the IDEA system when their child 

enrolls in a formal education program at ages 3, 4, or 5. However, 

Massachusetts and Hawaii serve at least the same number of children in 

their Part C programs as they do in their Part B Section 619 programs. 

Both states include at-risk children in their Part C eligibility criteria. 

Page 13 GAO-06-26 Individuals with Disabilities Education Act
Figure 3: National Percentage of Children Receiving IDEA Services by Age in 2004

0

1

2

3

4

5

6

7

8

Under 1 1 2 3 4 5

Percentage of children receiving services

Source: GAO analysis of the Department of Education’s 2004 IDEA data, IDEAdata.org.

Age

Part C Part B

1

2.2

3.7 3.8

6.2

7.6

States Face Challenges in 

Identifying All Children 

Eligible for Services 

Officials in the 7 states we visited told us that a number of obstacles 

prevented them from reaching all children, even though all of these states, 

as required by law, had developed public awareness campaigns to help 

identify infants and toddlers in need of services. To inform the public of 

the program, states used television, radio, and newspaper ads; 

presentations at community fairs; and distribution of pamphlets and 

brochures at doctors’ offices, hospitals, and other appropriate locations. 

For example, in one of the sites we visited, posters were developed to 

hang in doctors’ offices across the state to help inform parents about Part 

C. 

Despite their public awareness campaigns, the states we visited reported 

having difficulty reaching all eligible children. Officials noted that it can be

especially difficult to reach families for which English is a second 

language. While some states we visited produced public awareness 

materials in Spanish, they had not expanded their efforts to include 

materials in other languages. Officials also told us that it can be hard to 

reach families who live in rural areas because they may visit a pediatrician

less frequently because of the long distance they must travel to get to the 

doctor. While officials in 6 of the 7 states we visited noted that physicians 

Page 14 GAO-06-26 Individuals with Disabilities Education Act
were the principal source of referrals, they also told us that they believed

physicians were hesitant to make referrals to Part C programs because of 

a fear of misdiagnosing a child with a disability. They believed that a 

misdiagnosis could cause unnecessary anxiety in a parent whose child is 

developing more slowly but would eventually begin to demonstrate ageappropriate skills without needing early intervention services. 

Additionally, the American Academy of Pediatrics found through its own 

studies that a lack of understanding of the early intervention program’s 

processes and procedures is a barrier to physicians’ referring children. 

States provide a broad array of early intervention services to eligible

children and face similar challenges in recruiting and retaining staff to 

provide these services, but they vary in the sources of funding they draw 

from. States provide a wide range of medical and educational services to 

children and their families and rely on professionals, including 

occupational therapists, physical therapists, and speech language 

pathologists, to deliver these services. Yet officials in the states we visited 

reported that they are finding it increasingly difficult to recruit and retain 

these individuals. To fund early intervention services for children from 

birth to age 3, states relied on funding from multiple sources, including 

federal, state, and private funding. However, some states reported 

difficulties accessing certain types of funding, such as Medicaid. 

As required under Part C, states provide a broad array of early intervention

services to infants and toddlers. Under Part C, infants and toddlers with a 

disability are entitled to receive an evaluation of their strengths and needs, 

service coordination, and support for a smooth transition from early 

intervention to preschool programs. In addition, children receive 

individualized services that may include physical therapy, family 

counseling, and nutrition services. States, as required by law, reported 

making all services shown in figure 4 available to infants and toddlers. 

Selected States 

Provide Similar 

Services but Vary in 

Funding Sources 

States Provided a Broad 

Array of Services to 

Infants and Toddlers, but 

States We Visited Reported 

Challenges Recruiting and 

Retaining Staff 

Page 15 GAO-06-26 Individuals with Disabilities Education Act
Figure 4: Examples of Services States Made Available to Infants and Toddlers Covered by Part C

Assistive

technology 

services/devices

Audiology

 Family training

 and counseling

 and home visits

Health 

services

Nursing 

services

 Nutrition

services

 Occupational 

 therapy

Special 

instruction

Respite

care

Physical 

therapy

Medical

services

Psychological

services

Social work

services

Speech

language

pathology

Vision 

services

Source: GAO analysis of U.S. Department of Education's 2002 IDEA database.

Figure 5 shows that the most frequently received services nationwide are 

speech language therapy, special instruction, physical therapy, and 

occupational therapy. Psychological and nutrition services were among 

Page 16 GAO-06-26 Individuals with Disabilities Education Act
the least frequently provided. The states we visited were similar in their 

mix of services. For example, in states such as Maryland, Oregon, and 

Colorado, speech language, physical, and occupational therapy, to help

with skills like feeding, walking, and talking, were the most frequently 

provided services, and services such as psychological services and 

nutrition services were rarely provided. 

Figure 5: Percentage of Early Intervention Services Most Frequently Provided

0

4

8

12

16

20

Family training, counseling,

Occupational therapy

Physical therapy

Special instruction

Speech language

Percentage of all services provided

Source: GAO analysis of the Department of Education’s 2002 IDEA data, IDEAdata.org.

Services

 and home visits

20

18

14 14

8

therapy

These services were provided in a variety of settings, including the home, 

hospital, and day care, and through public and private service providers. 

For instance, according to Maryland officials, LEAs, departments of 

health, and departments of human services in the state provide services to

infants and toddlers in addition to private providers. In Massachusetts, a 

network of private programs provides early intervention services under 

contract with the state. 

Page 17 GAO-06-26 Individuals with Disabilities Education Act
Officials in each of the states we visited reported challenges in recruiting 

and retaining staff to provide early intervention services. Specifically, 

speech language pathologist and occupational therapist were the most 

difficult positions to fill. Officials cited several reasons for these 

challenges. Early intervention staff are required by Part C to serve children 

in natural environments, such as homes or child care centers. This 

requires staff to travel to these locations, which can be time-consuming 

and costly. For instance, in Hawaii, state officials told us that it is hard to 

schedule services for children in neighboring islands because of the long 

travel times to reach them. Additionally, state officials told us that salaries

earned by early intervention contractors were not always competitive with

salaries and benefits available in the private health care sector. These 

challenges make it difficult for some early intervention programs to hire 

professional staff. Understaffed programs can often result in heavier 

caseloads in which children do not receive services or receive services 

less often than intended.

States Use Various 

Funding Sources in 

Addition to Part C, but 

Selected States Report 

Difficulties Accessing 

Funds 

To help pay for services for infants and toddlers, states draw on a range of

federal, state, and local funding sources. As shown in figure 6, states 

accessed funds from a variety of sources at the federal level, including the 

Child Care and Development Block Grant, IDEA Part B, and Medicaid, and 

from the state level. See appendix I for a glossary of these federal and 

state funding sources. 

Page 18 GAO-06-26 Individuals with Disabilities Education Act
Figure 6: Examples of Federal and State Funding Sources 

IDEA 

Part B

Head Start

State 

Developmental

Disabilities

TriCare

Maternal and Child 

Health (Title V)

Children with Special

 Health Care Needs

Child Care 

Development

 Block Grant

 Medicaid (Title XIX)

Temporary Assistance

for Needy Families

Social Services 

Block Grant

Tobacco 

Funds

Source: 2003 state annual performance report data from OSEP.

Funding sources

State general revenue funds represent the most frequently used funds by 

states after federal Part C dollars. All 50 states reported using state general

funds. 

For most states we visited, local support represented a small proportion of 

reported early intervention funding, but in one—Maryland—it accounted 

for 51 percent. However, states did report receiving funds from local 

sources or through private insurance and fees collected from a child’s 

Page 19 GAO-06-26 Individuals with Disabilities Education Act
family. For example, New Jersey charges a sliding monthly fee based on 

family size and income relative to federal poverty guidelines. State officials 

said families that can afford to contribute to the cost of service provision 

do so, but families that cannot afford the fee still receive services. In fiscal

year 2003, New Jersey collected $43,862 in revenue from this fee, which 

made up less than 1 percent of its reported early intervention service 

funding. 

In 4 of the 7 states we visited, states provided most of the funding for 

services for infants and toddlers, and Part C represented a smaller 

percentage of total funding. For example, in Illinois, state general revenue

funds represented 57 percent of the total funding reported for infants and 

toddlers with disabilities, and Part C funds represented 17 percent. 

However, Part C represented a larger percentage of reported funding in 

certain states. For instance, in Colorado, Part C funds made up 38 percent 

of funds reported for infants and toddlers with disabilities. See table 1 for 

funding sources in the states we visited. 

Table 1: Sources of Funding for Early Intervention Services in Site Visit States 

(Dollars in millions) 

Part C Other federal Medicaid

State general 

revenue Other state 

Private 

insurance/fees Local support

Colorado $6.10 $0.00 $3.10 $6.80 $0.00 $0.00 $0.00

Hawaiia$2.00 $0.19 $0.02 $8.00 $0.01 $0.00 $0.41

Illinois $15.20 $0.00 $15.20 $49.70 $0.00 $6.20 $0.00

Maryland $7.60 $4.70 $1.80 $5.20 $2.30 $0.01 $23.20

Massachusetts $8.40 $0.21 $19.40 $29.90 $0.00 $32.20 $0.00

New Jersey $13.70 $0.50 $4.40 $40.60 $1.00 $0.04 $5.20

Oregonb$4.50 $0.00 $2.10 $8.00 $1.80 $0.00 $0.00

Source: GAO analysis of fiscal year 2003 data provided by state officials. 

a

Funding data for Hawaii are incomplete, as the state does not include data from its Public Health 

Nursing Branch and Healthy Start programs. 

b

Oregon’s Medicaid data are for both Part B and Part C; the state does not separate the two 

programs. 

Beyond our collection of funding data in our seven site visits, we looked at 

funding data for all 50 states by examining the information states provided 

to OSEP as part of their annual performance reports. Their data included

federal, state, and local funding sources, as well as the dollar amounts for 

each. However, during the course of our review, we found that data were 

incomplete. For instance, Hawaii did not report funding for two programs 

Page 20 GAO-06-26 Individuals with Disabilities Education Act
that provide early intervention services. We found similar gaps in 

examining funding data reported to OSEP by additional states.3

 During the 

course of our review, OSEP concluded the funding data from states were 

unreliable and announced plans to stop collecting such data.

States we visited reported challenges in accessing certain funding sources. 

For some smaller programs and funding sources, officials in some states 

we visited said the paperwork was too cumbersome for the small amount 

of funding they might receive in return. In other cases, some officials 

reported difficulty obtaining Medicaid reimbursement for Part C services. 

In Oregon, where the state department of education is the lead agency, 

officials explained that the different terminology educators use to describe 

certain needed services makes it hard to access Medicaid for early 

intervention services. For instance, Medicaid may pay for occupational 

therapy if the purpose is health-related in nature—such as teaching a child 

to eat. But Medicaid may not provide reimbursement if the stated purpose 

of the therapy appears educational, such as teaching a child to grasp a 

crayon to draw.4

 Despite the challenges some states reported, 

Massachusetts officials cited a strong and collaborative working 

relationship with Medicaid and private insurance. For example, since 1985,

the state has had operational standards that include reimbursement of 

virtually all Part C services through Medicaid. 

 3

 A 2004 expenditure study, conducted as part of the National Early Intervention 

Longitudinal Study, concluded that early intervention programs use a blend of federal, 

state, and local funding to provide early intervention services, but that while programs 

could report sources of funding, they had difficulty reporting precise amounts of funding or

breaking down the revenues by sources. 

4

 We earlier reported challenges in coordinating Medicaid and IDEA for school-aged 

children. See GAO, Medicaid and Special Education: Coordination of Services for 

Children with Disabilities Is Evolving, GAO/HEHS-00-20 (Washington, D.C.: Dec. 10, 

1999). 

Page 21 GAO-06-26 Individuals with Disabilities Education Act
OSEP monitors the states, which in turn oversee local Part C programs by 

examining data on how well programs identify, serve, and transition 

children to other programs when they are too old for Part C. In its 

oversight, OSEP tracks data on program performance submitted by states

through annual performance reports and other mechanisms. As part of its 

efforts, OSEP uses two key performance indicators—percentage of infants 

and toddlers receiving early intervention services and the percentage of 

these children receiving services in natural environments—to target site 

visits and technical assistance to programs most in need of guidance.

States oversee Part C in similar ways but are free, within certain 

parameters, to design their own oversight strategies. Although federal and 

state data and oversight efforts have helped identify some performance 

problems, challenges remain in transitioning children from Part C to Part 

B Section 619 and other follow-on preschool programs. In 5 of the 7 states 

we visited, officials said that some children who turn 3 during the summer 

and are eligible for Part B preschool experience service gaps when school 

is not in session. OSEP does not have data on how frequently children are 

provided extended year services during the summer months. 

To ensure that programs are managed well and that eligible infants and 

toddlers receive the services they need, OSEP monitors the states by 

collecting and tracking key data. Specifically, each state submits an annual 

performance report to OSEP, which includes a narrative on five areas of 

program performance and plans for improvement. States report on 

(1) what they are doing to identify children and the effectiveness of these 

efforts; (2) how well they are helping families develop the skills they need 

to help their children; (3) whether services are provided to children in a 

natural environment, such as, home, day care, or other programs for 

typically developing children; (4) whether transition planning is available 

to children and their families; and (5) what they are doing to supervise and 

manage local programs. States report on progress or challenges in meeting 

performance goals and state-developed indicators as well as projected 

timelines, activities, and resources needed to achieve future targets. For 

example, with respect to identifying all children eligible for services, 

Illinois set a goal for the period covering July 2003 to June 2004 to increase 

the percentage of children receiving early intervention services to 2.6 

percent of all children and to screen 200,000 children for developmental 

delays, approximately 37 percent of the state’s population age 0 to 3. In its 

annual performance report for that period, Illinois described the strategies 

it used to exceed its participation target—2.76 percent of children received

services—and explained why it fell 58,000 children short of its target for 

screenings. 

Both OSEP and States

Use Data to Monitor 

Part C Compliance, 

but Challenges Persist 

in Transitioning 

Children to Part B 

OSEP Monitors and 

Supports Implementation 

of Part C by Tracking Key 

Data 

Page 22 GAO-06-26 Individuals with Disabilities Education Act
In addition to information submitted as part of the annual performance 

reports, states also report data to OSEP in five areas: (1) number and 

percentage of children receiving services, (2) the specific settings in which 

children receive services, (3) number of children who stopped receiving

Part C services and the reason for stopping, (4) number and types of 

services provided, and (5) the number of clinical personnel employed or 

contracted to provide services. IDEA requires states to submit data in the 

first three areas, and OSEP, under authority granted to it in IDEA, requires 

states to submit data in the final two areas. For future reporting periods 

OSEP plans to discontinue collection of personnel data because they were 

found to be unreliable. Additionally, OSEP will stop collecting 

information about the number and types of services provided. The 

reporting data complement and inform topics covered in the annual 

performance reports. 

Failure to Reach a Key 

Child Identification 

Indicator Can Signal Part C 

Compliance Problems 

OSEP uses the annual performance reports and other reporting data to

identify problem areas and target its oversight efforts. In particular, OSEP 

compares states against the national average on two performance 

indicators: (1) the percentage of all infants and toddlers in the state 

receiving early intervention services, which was 2.2 percent as of 2003, and 

(2) the percentage of infants and toddlers with disabilities receiving early 

intervention services in a natural environment, which was 83 percent, as of 

2002.

5

 These indicators were developed by OSEP with input from 

interested parties, including states and the Centers for Disease Control 

and Prevention.6

 OSEP officials said they chose these indicators because 

of their confidence in the accuracy of the data and because they are 

closely linked to other Part C requirements. OSEP considers whether 

 5

 The national average for the percentage of all infants and toddlers receiving early 

intervention services is calculated based on the birth to age 3 population receiving early 

intervention services on December 1 divided by the total number of children ages 0 to 3 on 

that date. In 2004, 2.3 percent of the nation’s infants and toddlers received early 

intervention services. The national average for the percentage of infants and toddlers with 

disabilities receiving early intervention services in natural environments is calculated 

based on the number of children receiving services in a natural environment (homes and

programs for typically developing children) divided by the total number of children 

receiving services in all settings. 

6

 An initial baseline performance goal of serving 2 percent of states’ population ages 0 to 3

was based on conditions under observation by the Centers for Disease Control through the 

Metropolitan Atlanta Developmental Disabilities Study. These observations did not include

certain conditions covered by Part C that are difficult to detect in young children, such as 

learning disabilities and behavioral and social/emotional problems.

Page 23 GAO-06-26 Individuals with Disabilities Education Act
states have fallen below the national average when deciding whether to 

target states for technical assistance and closer monitoring. In 2003, half of 

all states served less than 2.2 percent of children. OSEP officials note that

the indicators do not directly measure compliance with Part C, but they 

serve as an early warning signal that states may need assistance. 

OSEP relies on the first performance indicator as a measure of the level of 

access states are providing for early interventions and the success of 

efforts to identify all eligible children. It has collected this performance 

information since at least 1996, and the percentage of the nation’s children 

between birth and age 3 receiving services has steadily increased since 

1998—from 1.6 percent to 2.2 percent in 2003. Twenty-five states met or 

exceeded this indicator in 2003. Of these 25 states, 7 served between 3.4 

and 7.7 percent. The fact that half of all states served 2.2 or more percent, 

and some served as high as 7.7 percent, combined with the known 

difficulties in reaching all eligible children, suggests that the actual eligible

population may be larger than the number of children states are 

identifying. The Centers for Disease Control and Prevention told us that 

comprehensive data on the number of children who could benefit from 

early intervention are not available. 

OSEP pays particular attention to states that do not meet its performance 

indicator. Failure to meet this indicator can be a signal that the state is not

doing enough to identify all eligible children and raise public awareness of 

available early intervention services. First, OSEP might encourage these 

states to seek help from technical assistance centers or OSEP staff. States

can get technical assistance on an ongoing basis through several vehicles,

such as conferences, six regional centers, research and training centers, 

and a national center. Second, OSEP might schedule a site visit, at which it

would interview state and local officials, providers, and parents and 

review program data in more depth. After OSEP completes a site visit, it 

prepares a monitoring report addressing strengths and areas of 

noncompliance with Part C. 

Using data from annual performance reports and site visits, OSEP has 

found states out of compliance with Part C for a number of issues related 

to the goal of identifying all eligible infants and toddlers for services. 

OSEP finds states out of compliance for, among other reasons, not making 

adequate public awareness efforts to inform culturally diverse groups 

about available early intervention services, not disseminating public 

awareness materials to pediatricians and other referral sources in rural 

areas, not referring children from underrepresented groups for services in 

a timely manner, and not carrying out service coordination 

Page 24 GAO-06-26 Individuals with Disabilities Education Act
responsibilities. Between July 1, 2002, and June 30, 2003, 14 states were 

found out of compliance with child identification requirements. These 

states served 0.9 to 7.7 percent of their population, with 9 of the 14 states 

serving less than 2.2 percent of their population. OSEP found Nevada 

(which was the state that served the lowest percentage of infants and 

toddlers at 0.9 percent in 2003) out of compliance for not ensuring that all 

children who may be eligible for early intervention services are identified, 

located, referred, and evaluated in accordance with Part C. Hawaii, which 

serves the largest percentage of children, including children at risk of 

having a substantial developmental delay, was found out of compliance 

because it lacked procedures to ensure evaluations and assessments were 

conducted in all the areas required by Part C. 

When states are not in compliance with Part C and do not show

improvement in their performance, even after receiving technical 

assistance, OSEP has several options. Initially, OSEP might work with a 

state on a plan of corrective action with a timeline, or issue a letter to the 

state documenting the specific problems. As a last resort, OSEP can 

impose formal sanctions against a state, including withholding funds, 

referring the matter to the Department of Justice, entering into a voluntary 

compliance agreement with a state and its respective lead agency that sets

a timeline for bringing the state into compliance, and incorporating special

conditions into a state’s grant award. OSEP reports that it rarely withholds

funds or refers any noncompliance issues for Part C programs to the 

Department of Justice. Two states, South Carolina and Arizona, are 

currently on compliance agreements, and several have special conditions 

in their grant awards.7

OSEP is using its second performance indicator, on the percentage of 

infants and toddlers with disabilities receiving early intervention services 

in a natural environment, in the same way it uses data about the 

percentage of all infants and toddlers in the state receiving early 

intervention services. OSEP officials told us that on the basis of provisions 

in the 2004 reauthorization of IDEA, they recently developed a new set of 

performance indicators. States will submit to OSEP baseline data on these 

measures in December 2005. The new indicators generally build upon data 

currently being collected to look in new ways at how states provide early

 7

 For additional information on OSEP’s efforts to address issues of noncompliance under

Part B of IDEA see GAO, Special Education: Improved Timelines and Better Use of 

Enforcement Actions Could Strengthen Education’s Monitoring System, GAO-04-879 

(Washington, D.C.: Sept. 9, 2004). 

Page 25 GAO-06-26 Individuals with Disabilities Education Act
intervention services in a natural environment, identify children, transition 

children to follow-on services, and address supervision and management 

issues. For example, the new indicators for identifying children include a 

comparison of the percentage of children served in each state with the 

average in other states with similar eligibility criteria, and information 

about the percentage of children who proceeded through the evaluation, 

assessment, and service planning stages of the early intervention system 

according to timelines required by Part C. Similarly, the new transitioning 

indicators require information about the percentage of children who 

receive timely transition planning. 

States Have Responsibility 

for Oversight of Local 

Early Intervention 

Providers 

State lead agencies play a critical role in monitoring and supporting early 

intervention services through their responsibility for local Part C 

programs. Instead of directly providing services to infants and toddlers 

with developmental delays, in the states we visited, local and regional 

early intervention programs generally deliver and coordinate services. The 

states, then, are responsible for ensuring the local programs are in 

compliance with Part C. States use many of the same approaches as OSEP 

in monitoring and supporting local programs, such as file reviews, 

reporting requirements, program certification or funding awards, 

employing training and technical assistance staff, and monitoring visits. 

States frequently interact with local early intervention programs. For 

example, Massachusetts officials seek to visit half of their 63 local 

programs each year. 

OSEP encourages collection of outcome data from parents and is 

sponsoring research on outcomes, which is scheduled to be completed in 

2006. At least 4 of the states we visited monitor early intervention services 

by conducting parent surveys. The surveys measure parental satisfaction 

with the delivery of early intervention services, how well parents feel 

services are coordinated, and parents’ experiences working with staff to 

transition their children to follow-on services. OSEP provides funding for 

technical assistance to help states develop parent surveys. These survey 

data and information from OSEP’s National Early Intervention 

Longitudinal Study are potential sources of outcome data about early 

intervention services. Additionally, the Early Childhood Outcomes Center, 

a 5-year project funded by OSEP, is providing technical assistance to 

support states in developing and implementing other outcome 

measurement systems for children with disabilities. The Early Childhood 

Outcomes Center is attempting to develop outcome data that can be 

aggregated at the national level, document program effects, and improve 

programs at the local and state levels. 

Page 26 GAO-06-26 Individuals with Disabilities Education Act
State Part C officials we spoke with explained that they have to hold local

early intervention programs accountable for the same performance 

indicators for which OSEP holds them accountable. As with OSEP, state 

Part C coordinators have taken actions to enforce compliance with IDEA. 

Officials in Colorado said they had taken away funding from programs that 

failed to comply with Part C requirements. Also, when states fail to 

enforce IDEA requirements, they risk not only being found in

noncompliance, but also lawsuits brought by individuals under IDEA. Such 

was the case in Hawaii and Illinois. In Hawaii, parents and mental health 

advocates alleged that qualified handicapped children were not receiving

mental health services. In Illinois, plaintiffs alleged that the state had a 

waiting list for children who were eligible for services. Both states settled 

the lawsuits by agreeing to take specific steps to come into compliance 

with the act.

Overseeing and 

Coordinating Transitions 

to Part B Remains a 

Challenge 

Although the information that OSEP and the states compile has helped 

identify some performance problems, overseeing and coordinating 

children’s transitions to IDEA Part B remains a challenge. The transition 

process involves several sequential steps, and when any of these steps are 

delayed, a child could miss out on critical services and providers can be 

left without important information on a child’s status. As a child nears age 

3, local early intervention staff must inform the child’s family about followon programs that may be available for the child, such as Part B Section 

619. Local early intervention staff, with the approval of the family, hold a 

conference with the family and, if the child is potentially eligible under 

Part B, LEA officials, to discuss any services the child may be eligible to 

receive. This transition planning conference for children potentially 

eligible under Part B, must occur at least 90 days before the child’s third 

birthday. Early intervention staff and the family must develop a written 

transition plan. And if the child is believed eligible for Part B services, 

early intervention staff must notify the LEA. The LEA must determine the 

child’s eligibility within a reasonable time frame, and if the child is found 

eligible, a meeting to develop an individualized education program (IEP) 

for the child must be conducted within 30 days. Part B requires teachers,

parents, school administrators, and related services personnel to develop 

the IEP shortly after a child is found eligible for Part B services, and the 

IEP guides the delivery of special education supports and services for a 

student with disabilities. 

While IDEA requires states and local programs to provide transition 

planning and follow these specific procedures, we found in our site visits 

that delays still happen. Education cited preliminary unpublished data that 

Page 27 GAO-06-26 Individuals with Disabilities Education Act
would suggest transitions are a year-round problem. We found that delays 

generally occur for two reasons. First, data in annual performance reports

indicate that some states have difficulty scheduling transition meetings 90

days in advance of a child’s third birthday. State and local officials we 

interviewed said it was difficult to assemble all of the requisite individuals 

for the conference before the deadline. Second, some state officials 

expressed concern about the timing of the LEA’s decision on a child’s 

eligibility. The decision may be delayed until the following school year for 

children with summer birthdays because LEAs generally operate on a 9- or 

10-month academic calendar. In 5 of the 7 states we visited, officials said 

that some children who turn 3 during the summer and are eligible for Part

B preschool experience service gaps when school is not in session. As a 

result of these delays in the transition process, some children who need 

extended school year services during the summer may not receive them. 

Most of the states we visited do not keep track of the number of eligible 

children who do or do not receive extended school year services. 

There are two potential ways to ensure children do not experience gaps in

services. First, extending Part C services until children are eligible to enter 

kindergarten, which was permitted for the first time with the 

reauthorization of IDEA in 2004, could mitigate some of the challenges 

associated with transitioning children. However, none of the states we 

visited plan to exercise this option. States indicated that it would be too 

costly for them to extend Part C service and that Part B officials are not 

willing to support doing so with Part B Section 619 funds. Second, Part C 

funds can be used to provide services to children from their third birthday 

to the beginning of the following school year, but an OSEP technical 

assistance center reports that as of 2004, while 30 states permit such use 

of Part C funds, only 14 states have adopted such a policy. 

In addition to citing delays, state and local officials cited other obstacles to 

a smooth transition for children. Local early intervention programs 

sometimes have to work with multiple LEAs that each have their own 

eligibility criteria for Part B, which complicates coordination. For 

example, a local Massachusetts official said that her early intervention 

program spans a geographical area that encompasses 13 different LEAs. 

Also, LEAs sometimes conduct their own evaluations, contributing to the 

time needed for determining Part B eligibility. 

State and local officials also reported that early intervention programs 

often do not get final notification of a child’s eligibility for Part B services 

from the LEA. According to OSEP, this information exchange may not 

occur for several reasons, including federal laws relating to privacy and 

Page 28 GAO-06-26 Individuals with Disabilities Education Act
the need for parental consent to share results of Part B evaluations. 

Without access to information on eligibility decisions, early intervention 

staff do not know whether they need to refer children who are denied Part

B services to other follow-on programs, like Head Start. State Part C 

officials are required to report Part B eligibility information to OSEP when 

reporting why a child stopped receiving services, but LEAs that administer 

Part B do not always provide this information in a timely manner, if at all.

While two of the states we visited are in the process of developing 

mechanisms for ensuring early intervention staff have access to eligibility 

information, none are currently in use.8

 OSEP staff acknowledged that 

states need continued support to ensure Part B officials share eligibility 

information with early intervention staff. 

Scientific research suggests that the earlier a child with disabilities gets 

intervention services, the more effective these services may be in 

enhancing a child’s development. Before a child enters preschool, states 

have substantially greater flexibility in determining which infants and 

toddlers to serve. IDEA gives states the freedom to set different eligibility 

criteria for early intervention services and decide how they will evaluate 

children for eligibility. However, it is partly these variations that make it 

difficult to determine if states are actually meeting the early intervention 

needs of all their developmentally delayed infants and toddlers. 

Conclusions 

One of the most pressing challenges is transitioning young children with 

disabilities from services provided under IDEA Part C to Part B preschool 

or other services at age 3. This transition requires that a sequence of

determinations and agreements among multiple stakeholders take place in 

a timely way. Education reported in its comment that it has preliminary 

data that suggest that service gaps may occur whenever children 

transition. In our interviews with state and early intervention officials, we 

found that transition is perhaps most challenging for children who 

transition during the summer months. If determination of eligibility for 

Part B is delayed, children can be prevented from receiving necessary 

services, including those provided through extended school year programs 

in the summer. Based on our findings, and Education’s preliminary 

findings from its ongoing study of preschool services, it appears that 

 8

 The most recent reauthorization of IDEA in 2004 includes a provision for the local 

educational agency under Part B to invite, at the request of the parent, the Part C 

coordinator or other Part C representative to the child’s initial individualized education 

plan meeting. 

Page 29 GAO-06-26 Individuals with Disabilities Education Act
without additional guidance, some children exiting the Part C program and 

eligible for Part B preschool may not receive all the services for which 

they are eligible. 

In order to assist states in providing a more seamless transition for 

children with disabilities from IDEA Part C to Part B, or other preschool 

programs, we are recommending that the Secretary of Education provide 

states with additional guidance on transition planning and services for 

children with birthdays during the summer, and especially in cases where 

children are likely to need extended school year services. Additionally, 

after Education completes and verifies the results from its ongoing studies 

relating to transitioning, that information should be used to inform the 

department’s guidance to states on transition planning. 

We provided a draft of this report to Education for review and comment. 

Education disagreed with the recommendation we made to incorporate 

into its research agenda a method for determining how frequently children 

transitioning from Part C to Part B do not receive services during the 

summer months, and if gaps in services are found to be a problem, provide 

states with additional guidance on improving children’s access to 

extended school year services. Education noted that preliminary and 

unpublished data from a department study indicate that gaps occur when 

children are transitioned from Part C to Part B, not only during the 

summer, but whenever transitions occur. Additionally, Education stated 

that based on its preliminary data, there is no need to study extended 

school year service. We believe it is critical to provide children with the 

services they need when they need them. If Part B eligibility is not 

determined prior to children turning 3 during the summer months, then 

related decisions, including those about extended school year services, 

cannot be made. We believe that by providing additional guidance, 

Education can help states improve transition planning and services and 

help ensure that children do not experience gaps in services during critical 

periods of their development. 

Recommendations for 

Executive Action 

Agency Comments 

and Our Evaluation 

Education also provided technical comments that we incorporated into 

the report where appropriate. Education’s written comments are 

reproduced in appendix II. 

Page 30 GAO-06-26 Individuals with Disabilities Education Act
We will send copies of this report to the Secretary of Education, 

appropriate congressional committees, and others who are interested. We 

will also make copies available to others upon request. In addition, the 

report will be available at no charge on GAO’s Web site at 

http://www.gao.gov. If you have any questions about this report, please 

call me at (202) 512-7215. Key contributors are listed in appendix III. 

Sincerely yours, 

Marnie S. Shaul, Director

Education, Workforce, and 

 Income Security Issues 

Page 31 GAO-06-26 Individuals with Disabilities Education Act
Appendix I: Select Federal and State Funding Appendix I: Select Federal and State Funding Sources for Early Intervention Services 

Sources for Early Intervention Services 

The Child Care and Development Block Grant program is a 

discretionary fund program that, among other things, supports state 

efforts to provide child care to parents trying to achieve independence 

from public assistance. 

Children with Special Health Care Needs refers to a type of program 

operated by particular states that provides financial assistance or case 

management for needed medical treatment to children with serious and 

chronic medical conditions to reduce complications and promote 

maximum quality of life.

Developmental Disabilities Services refers to state programs that serve 

and support individuals with mental retardation/developmental disabilities 

and their families, including early intervention services. For example, 

community developmental disability services are supported by state 

funding in Kansas, which defines community developmental disability 

services as those designed to meet needs associated with work, living in

the community, and individualized supports and services.

Head Start and Early Head Start are comprehensive child development 

programs that serve children from birth to age 5, pregnant women, and 

their families. These programs are federally funded and locally

administered by community-based nonprofit organizations and school 

systems. Grants are awarded by the Department of Health and Human 

Services. 

IDEA Part B, administered by the Department of Education, provides 

grants to states to provide preschool services to children with disabilities 

from age 3 to 5. 

The Maternal and Child Health Services Block Grant program (Title 

V of the Social Security Act) provides federal grants to states and 

organizations with the aim of improving the health of mothers and 

children. Among the many services supported by grants are support 

programs for children with special health needs, care coordination, 

transportation, home visiting, and nutrition counseling. 

Medicaid is health insurance that helps people who cannot afford medical 

care pay for some or all of their medical bills. Medicaid is jointly funded by 

the federal and state governments to assist states in furnishing medical 

assistance to eligible needy persons.

Page 32 GAO-06-26 Individuals with Disabilities Education 
Appendix I: Select Federal and State Funding 

Sources for Early Intervention Services 

The Social Services Block Grant (SSBG) program allocates federal 

funds to states to support a wide variety of social services programs for 

adults and children. 

Temporary Assistance for Needy Families (TANF) is a family 

assistance block grant from the Department of Health and Human Services 

to states that can be used to provide monthly cash assistance payments to 

families as well as to finance services for TANF clients or other lowincome people to support their efforts to work. 

Tobacco Funds were awarded to states as part of a settlement agreement 

with major tobacco companies. Kentucky designated 25 percent of its 

Phase I settlement to an early childhood initiative that includes First Steps, 

its early intervention system. Kansas allocated all of its settlement for 

children’s services. 

TRICARE is the Department of Defense’s regional managed-care program 

for delivering health care to members of the armed services and their 

families, survivors, and retired members and their families. TRICARE 

operates like health maintenance organization plans offered in the private 

sector and other similar health insurance programs. 

Page 33 GAO-06-26 Individuals with Disabilities Education 
Appendix II: Comments from the Department of Education Appendix II: Comments from the Department 

of Education 

Page 34 GAO-06-26 Individuals with Disabilities Education Act
Appendix II: Comments from the Department of Education 

Page 35 GAO-06-26 Individuals with Disabilities Education Act
Appendix III: GAO

St

 Contact and 

aff Acknowledgments

Page 36 GAO-06-26 

Appendix III: GAO Contact and Staff 

Acknowledgments 

GAO Contact Marnie S. Shaul (202) 512-7215 or shaulm@gao.gov 

In addition to the contact named above, the following individuals made 

important contributions to this report: Betty Ward-Zukerman, Assistant 

Director; Ramona Burton, Analyst-in-Charge; Daniele Schiffman, Analyst; 

Rachael Chamberlin; Sherri Doughty; Avrum Ashery; Jonathan McMurray; 

Beverly Ross; and Daniel Schwimer. 

 Individuals with Disabilities Education Act

Staff 

Acknowledgments 

(130406) 
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