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