Rescheduling/Missing Visits with Families

With the holidays and wintertime upon us, we wanted to share this piece of guidance with all of our providers regarding rescheduling missed visits with families. The following is an excerpt from the Q/A available on the DESE website:

Question 1: If a regularly scheduled visit with a family falls on a national holiday, are providersrequired to make-up the visit?
Answer: If a provider's regularly scheduled visit falls on - New Year's Day- Memorial Day,- Fourth of July, - Labor Day, - Thanksgiving Day or - Christmas Day, the provider would NOT be expected to offer the family a make-up visit. For example, if a provider sees a family every Thursday, the provider would not be expected to offer the family a make-up visit for a visit missed due to Thanksgiving.

Question 2: If a provider misses a scheduled visit for any reason, is the provider required tomake-up the visit?
Answer: YES, it is expected that the provider will make up the visit as soon as possible. If theprovider is unable to make-up the visit within the current IFSP period, the provider musthave a conversation with the family and the service coordinator to determine how themissed visit will be provided. The decision should be entered in the service coordinator'scase notes in WebSPOE.

Question 3: How are visits and consultations handled when a provider takes maternity leave?
Answer: Prior to taking maternity leave, the provider should begin having conversations withfamilies and service coordinators to develop a plan for provision of services while she ison leave. A plan may include a substitute provider, changing providers permanently, ormake-up visits once returning from maternity leave (e.g., if only seeing a child monthly,quarterly, etc.). If substituting or changing providers, the service coordinator must bemade aware of the change at least one week before the start date of the new provider inorder to make the needed changes to the authorizations.

Question 4: If the family misses a scheduled visit for any reason, is the provider required to make-up the visit?
Answer: When a family misses a visit, the issue of whether or not that visit should be made upis individualized to the needs of the child and family. If a family frequently misses visits,the service coordinator should convene the IFSP team to discuss with the family why theservices were missed and to determine the appropriateness of making up the services.IFSP teams should consider the impact of the missed visits on the child's progress anddetermine how to ensure the continued provision of services in order for the child tocontinue to progress towards the outcomes of the IFSP.

Question 5: If a provider arrives for a scheduled visit and the family is not present, how does aprovider bill for this?
Answer: If a provider arrives for a visit and discovers that the family is not there, the provideris allowed to bill 1 unit (15 minutes) and mileage related to this visit. If this visit isrescheduled with family for a later date, the provider can either1) shorten the make-up visit by 15 minutes; OR2) keep the rescheduled visit at the full intensity. If the provider runs out of units before the end of the IFSP period, the provider should speak to the service coordinatorabout additional time.If a provider is en route to a visit and the family calls to cancel, this CANNOT be billed as amissed visit.

Question 6: Where should providers document missed visits and plans to reschedule?
Answer: All records of missed visits and cancellations should be documented in the child'sprogress notes. The progress note should include:. the date of service. why the visit was cancelled. who initiated the cancellation. all phone attempts to reach the family to schedule visits. any difficulty contacting the family, and. the plan to reschedule the visit, if needed.

EIT 101 in St. Louis

We have now scheduled EIT 101 meetings for the St. Louis Metropolitan Area. These meetings are scheduled as follows:
January 13- 2pm @ The Crossings at Westport
11969 Westline Industrial Dr.
St. Louis, MO 63146

January 14- 10am @ The Crossings at Westport
11969 Westline Industrial Dr.
St. Louis, MO 63146

January 14- 5pm @ Special School District Central Office (room 60)
12110 Clayton Rd
St. Louis, MO 63131

During these meetings, Marcy Morrison, Area Director with DESE, will provide a presentation regarding the fundamentals of EIT along with opportunities for questions and answers. Space is limited so please RSVP with Ellen Mersman: emersman@awsusa.com or call the SPOE office at (314) 453-9203.

Quality DAYC Reporting Criteria

Quality DAYC reports serve two purposes in the First Steps process: 1) to determine eligibility for children who are referred to First Steps due to concerns about a possible developmental delay, and 2) they are used in developing the initial IFSP for the family. A copy of this report should be given to the family, so it is important to use family-friendly language that is easy to understand and not offensive or harsh. If a provider has specific concerns and/or impressions/opinions about what they saw during the evaluation, those thoughts should be shared with the Family Service Coordinator outside of the DAYC report. For example, words like “atypical,” “significant,” and “abnormal” can be alarming to families. When DAYC reports are written and reviewed, we should be considering the audience and writing them knowing that parents will read them. We should keep in mind the feelings of our parents when writing the reports and consider what words would be helpful and hurtful. Instead of saying “Jimmie has significant regression with feeding skills that are atypical for his development and this continued pattern is sure to impact him negatively,” you could say “Jimmie used to eat some solid foods with his family but will now only take a bottle. His parents are concerned because he is 12 months old and they would like him to be eating some of their family meals with them.”

Any assessment protocols that are considered in addition to the DAYC can be discussed in the summary section but should be written in a way that families will understand. For example, families may not understand all of the jargon involved with sensory profiles, so that needs to be written in a way that is very easy to understand. We also expect providers and service coordinators to communicate often during the intake process in order to keep everyone informed during this process with families. If the SPOE receives a DAYC report that is not of quality standards or is questionable, the service coordinator will contact the provider and have a discussion about changes that need to be made. It is our expectation that the need to return a report to a provider for changes will be rare after this DAYC Reporting Criteria has been shared with providers. We are expecting high quality reports with rich, individualized family friendly detail!

What Quality DAYC reports should always include:

• statements of family routines


• strategies and activities across all areas


• information specific to the individual child and family; not cut and paste or cookie cutter


• statements written in family friendly/centered language that do not emphasize the negative with "harsh" words


• a detailed description of what was observed during time spent with the child and family


• a quick turn around time based on the date on the Provider Request Form from the Family Service Coordinator


• likes and dislikes including motivators for the child


• fears of the child


• specific examples of skills from the parent of caregiver


• a rich description included in the child and family section of any information that is not captures in the domain sections of the DAYC report


• a mention if the child has had any opportunities or exposure to a specific skill/task prior to the evaluation

What Quality DAYC reports should not include:

• language and statements that are not accurate nor do they match the findings in the domains


• narrative information that is not specific to the child


• generic listings of skills activities/strategies that are not specific to the particular child and family routines


• listing skills directly from the DAYC protocol


• statements that list too much of what a child is "not doing"


• negative or harsh language such as "significant delay, abnormal, regression, atypical"


• spelling errors, grammatical errors (including child/parent names and child's date of birth), all lowercase/uppercase words


• therapeutic/clinical/medical/discipline-specific jargon


• references to "area or concern" or "area of weakness"


• recommendations for therapy or other services

Please Note: There is a new DAYC report summary form available on the First Steps page on DESE's website. This is the correct form that is to be used for all DAYC reports as of September 2009. The form can be found by following this link:

http://www.dese.mo.gov/divspeced/FirstSteps/DAYCtemplatefillform0909.docx

Stay Up To Date with EIT Planning

The St. Louis Area SPOE's goal to implement Early Intervention Teams in the St. Louis Metropolitan Area is in direct agreement with DESE's plan to move forward with this method of early intervention support for children and families throughout the state.

(Click here to see DESE's document entitled "Path to Early Intervention Teams"
www.dese.mo.gov/divspeced/FirstSteps/documents/PathforTeamdevwithbackgroundinfo0909.pdf)

Part of our responsibility is to not only inform the community during this transition but to also gather information about the unique needs of our region which we plan to do through a series of Work Group meetings with specific stakeholders. Our plan is to present, along with DESE, the philosophy behind the EIT model (EIT 101) and to discuss elements of our own plan to move forward with this model in the St. Louis Metropolitan Area. We plan to hold a series of meetings throughout the area starting in January 2010. We will invite key individuals to participate on the Work Groups which will include parents, providers, school district personnel, parent educators, and members of the medical community.

Further inf0rmation regarding invitations to these Work Group meetings will be made available once dates and locations have been set.

Changes to EIC (RICC) for SPOE Regions 1 & 2

Now that our 2 SPOE Regions have been combined to operate cooperatively out of one SPOE office, so too shall our RICC be combined and begin to meet together as one group. Beginning in December, there will be one RICC mtg held between Regions 1 and 2. Our next meeting will be Thursday, December 17, from 1:15 – 3:15 at Moog Center for Deaf Education, 12300 South Forty Drive St. Louis, MO 63141, (314) 692-7172.

New Director Appointed

As you are aware, we have a management change with the resignation of Juli Hillyer, Director for Region 2. Over the years, Juli has made significant contributions to First Steps families and stakeholders. She will be missed. Please help me in wishing Juli the very best in her new venture. Her last day will be Friday November 20, 2009.
On behalf of AWS, I am pleased to announce the promotion of Lead Service Coordinator, Ashlie Klopper to Director of Region 2, effective November 23, 2009. Ashlie comes to this position with knowledge, strength and leadership. We believe that this transition will be smooth and seamless.
Thank You
Elaine Armstrong, VP
AWS

SPOE Management Update Regarding Long Time Director, Julia Hillyer

"I am resigning from my position as SPOE Director for Region 2. Elaine Armstrong and I have agreed that my last day at the SPOE will be Friday November 20th. I have accepted the position as the Tri County Regional Director with the Department of Mental Health.

I have thoroughly enjoyed my 15 years working in First Steps and my time with all of you. I appreciate the hard work you do on a daily basis for children and their families. I am confident that SPOE 1 and SPOE 2 will continue to be leaders in Early Intervention and represent Missouri First Steps and AWS in the highest regard. Thank you."

Julia A. Hillyer, M. A.
Director-Region 2
First Steps-St. Louis

Updates on Provider Progress Note Reporting in WebSPOE

During our recent DESE Compliance Monitoring in August, we discovered a need to provide more clarification to the field regarding provider progress reporting in WebSPOE. For the most part, providers are successfully completing notes in the system for FSCs to review, but we want to make sure that everyone is aware of what is generally required for Provider Progress Note Reporting:

• Make sure you are reporting on a regular basis-notes should be entered at least once during the month that you are authorized to visit the family.
• Include the dates of your visit(s) in your notes (for example- "ST visited Sonny and his family at home 2 times this month on 10/5 and 10/19")
• If you miss a visit, please include this information in your note as well (for example- "PT visited Daisy and her family 1 out of 2 times on 9/3. Missed visit on 9/20 due to provider illness" ). When you are able to make up the missed visit(s), please include that information in your note as well (for example- "PT made up missed visit from 9/20 on 10/7" )
• When entering the content of the notes, please make sure to include strategies/activities and routines that you are discussing/reviewing with the family. These strategies and activities should relate directly to the outcomes in the child's IFSP.

Your provider progress notes are a very important piece of the IFSP/Early Intervention process. Through review of these notes, we are able to insure that quality supports are being provided in accordance with the IFSP as well as document the child and family progress in the program. Also, the progress notes are made available to families for their own records in addition to helping with transition.

Thank you for your continued dedication to children and their families! If you have any questions or comments regarding progress note requirements, feel free to contact your Family Service Coordinator or the SPOE Director.

Settling In...

Dear Providers, 
It has been awhile since we have used this tool to communicate information about the program. That was not our intent; however, it is the reality of transitioning the program from 2 previous contractors, bringing together 2 teams of people, settling in to a new office, hiring new staff and preparing for an audit. All of this while, the day-to-day operations of the program successfully began on July 1st.

It has been a busy 2-3 months. We have accomplished a lot and the team has much to be proud of. All in all, the transition has gone well.

Now, we take the next step. The next step toward refining the program and building the future. We will need your help. 

Previously, a commenter asked:  "Will there be any informational meetings for providers?"

The answer is:  Yes!  We will post details here once plans are finalized.

Also, stay tuned for announcements, more information and updates, as we will begin posting SPOE and state updates here, too. You will have the opportunity to ask questions and seek clarification by posting a "comment". This will allow everyone to have the same information at the same time. 

Thank you for your dedication to children and families!

St. Louis Area SPOE Office

The contact information for the St. Louis Area SPOE office (serving Regions 1 and 2):

St. Louis Area First Steps
1215 Fern Ridge Pkwy, Suite 101
St. Louis, MO 63141

phone: 314-453-9203
fax: 314-453-0802

Region 1 Director: Howard Smith
Region 2 Director: Julia Hillyer

Meet & Greet Info

Please join us at one of the following "MEET & GREET" events to learn more about AWS, our vision for the St. Louis Area SPOE and networking!

Location:
Auditorium, Thornhill Branch: St. Louis County Library
12863 Willowyck Dr. • St. Louis, MO 63146 • (314) 878-7730

Tuesday, April 21st
10:00am - 11:30am
12:00pm - 1:30pm

Wednesday, April 22nd
9:30am - 11:00am
12:30pm - 2:00pm
2:30pm - 4:00pm
5:00pm - 6:30pm

Service Coordinators and current SPOE staff:
We will review the application, interview and hiring process. Hope to see you there!

Early Interventions Teams clarification

We have received several inquiries about EITs and job/contract opportunities for therapists. At this time, our proposed EIT plan is a DRAFT. We will be meeting with the other SPOE contractors and DESE to develop and plan the EIT implementation schedule in the coming months. Stay tuned... :-)

Save the Date!

"Meet & Greets" ~ We are planning a few opportunities for the First Steps community (especially, providers and Service Coordinators) to meet with the AWS administrative team leading the SPOE transition. These will be on Tuesday, April 21st and Wednesday, April 22nd at various times. More details to follow!

Coming Soon

All updates regarding the Missouri First Steps SPOE contracts for Regions 1 and 2 will be posted here. Please check often.

We look forward to working with you!