ROUGH EDITED COPY
Utah State University - Casey Judd
EHDI-WILLIS
The Maine Model...Collaboration leads to one statewide system of
Early Intervention
March 10, 2015
2:15 p.m. ET
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This is being provided in a roughdraft format. Communication
Access Realtime Translation (CART) or captioning are provided in
order to facilitate communication accessibility and may not be a
totally verbatim record of the proceedings.
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>> If you are not staying for the second session, could you
please leave your evaluations in your chair? Or leave your
evaluations on the table. We will dive into the second session,
because we are in a tight timeframe. This session is called the
Maine Model, collaboration leads to one Statewide system of
Early Intervention for Deaf and Hard‑ of‑ Hearing Infants and
Toddlers. Again please they have handouts ‑ ‑ if you already
have a evaluation form hand back to me when we're done thank
you.
>> Hi. Welcome. Ready to start?
Those of you that were in the previous presentation, at the
beginning, lots of roads of deserts. In Maine we have roads and
roads of trees. So just to give you point of reference it's a
little bit different if talking about our state, as opposed to
Nevada.
[ Audio breaking up ]
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>> Testing. All right.
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>> KAREN HOPKINS: How's that? Is it on? Good? Okay.
We are representing the State of Maine with kind of innovative
Part C model that we're doing. And we wrote an MOU, a memo of
understanding, that we'll share with you today and called it our
Maine Model. Talk about collaboration. My name is Karen
Hopkins and I am the director of Maine Educational Center for
the Deaf and Hard of Hearing from the Maine Center of Deaf and
Hard‑ of‑ Hearing. Maine Educational Center for the Deaf and Hard
of Hearing underneath that, is a program Early Childhood and
Family Services. The acronym is ECFS. You will see that
throughout the next half hour. ( Inaudible ).
[ Off microphone ]
>> ( Inaudible ).
[ Off microphone ]
Mic issues.
>> KAREN HOPKINS: Pass it back and forth instead of just holding
one? Is that the problem?
>> I think this one works.
>> KAREN HOPKINS: Okay.
Are we good? All right.
Okay.
>> ROY FOWLER: As I was saying, I am Roy Fowler I am with the
Child Services Maine technical advisor. Part C coordinator, but
in Maine I am the technical advisor. So child development
Services is under the Maine Department of Education and we're
the lead agency in the state for Early Intervention Services.
We have nine sites throughout the state and several satellite
offices. Those of you who were here earlier listening to
Nevada, we're kind of in the same situation where we have a lot
of square miles, but not a lot of population. Our population is
just slightly over a million.
And on average, on a yearly basis Maine CDS, serves
approximately 900 infants and toddlers through our Early
Intervention Services. In the last couple years, Maine has
implemented the primary service provider model and we blended
that with the routines‑ based Early Intervention model.
And for those of you who aren't familiar with that I will give
you a brief rundown. Basically a primary service provider model
has one primary person, that goes into the house on a regular
basis and that person is selected based on the family and
child's needs and priorities.
And that primary service provider comes from a group of
professionals you see there. Each site that we have has special
education teachers, PTs, OTs, SLPs, and social workers. So any
of those people can be the primary service provider. So the
primary service provider is the one that goes that the house on
a regular basis, but they receive ongoing support from the rest
of the team and that can be through either the weekly meetings,
that can be consultant or joints visits going out to the home
and we can access those consultant or joints visits as often as
needed. It's a very flexible model.
>> KAREN HOPKINS: Then we have the Maine Educational Center for
the Deaf and Hard of Hearing. This is a state agency for deaf
education that serves birth‑ through‑ grade 12 and a variety of
services and programs, Both Center based and outreach throughout
the State of Maine going into homes and public schools and again
the program we are talking mostly about today is Child
Development Services. That focuses on families in homes have
babies birth to 3 as well as preschoolers 3 to 5 traveling
throughout the state, homes, daycares, preschools regardless of
communication modality.
Team is highly qualified supportive team is diverse. It's
unique. We have everything from early childhood deaf educators,
teachers of the deaf ASL trained and aurally trained. We have
speech pathologists. We have LSLS ‑ ‑ cued speech providers,
educational audiologists and a deaf hearing team which, I think,
is kind of has a lot of worth to it merit and I think Roy and I
maybe ‑ ‑ always talking about the differences of the deaf
hearing aspect brings to this work. And that's kind of the crux
of this MOU, as opposed to some other MOUs that might happen
with Roy. He's new to this and always say, wow, this is huge
and it is huge. So really looking at it from a deaf perspective
and a hearing perspective is part of the process that we have
done.
>> ROY FOWLER: Prior to the MOU, oftentimes, referrals would go
to ECFS or CDS, sometimes both sometimes neither. Bask
basically a lot kids of and families got services from whoever
came first and they often ran parallel so ECFS staff would be
providing their services and CDS staff ‑ ‑ the communication
between the two agencies were good. But a majority of sites
that was there no communication back and forth. Oftentimes no
communication between the treating ‑ ‑ and conflicting
information, conflicting strategies, conflicting guidance really
left families in the middle.
And also when you think about the burden on families from
receiving services from two different agencies at the same time,
there's multiple visits a week, there's the burden of intake
with two agencies, telling the stories twice, multiple
evaluations, multiple appointments. And so not only it is
inefficient way to provide services, but the time demand for the
families was incredible.
>> KAREN HOPKINS: We realized two state agencies with two
mandates. Part C in a mandates and MECDHH had mandates and our
statutes from the state so we were doing a we were told to do
and vice versa, but not really interacting a lot.
So we decided really have to look at this getting feedback from
professionals, feedback from families and just felt it wasn't
working. So way back 25 years ago when I started working in
Early Intervention in Maine, there was another Part C provider
we did a lot of work in the same area worked together I moved to
a coordinator position, she moved to the Director of Child
Development Services we got to those positions we said we have a
lot of history and we know what works and what we feel didn't
work so well.
We also had some new leadership in Maine ‑ ‑ opened up the doors
for new beginning and new discussion. Which was really helpful
in our process. We decided we were going to meet and meetings
and meetings and meetings as you know take time and effort. So
we established a lot of meetings. In a row.
And we said let's get a facilitator. Let's make sure that our
meetings are balanced and we stay on track and we have an agenda
and set ‑ ‑ and do other things you are supposed to do at
meetings. We then sat down and identified the issues. What are
the problems that we have seen? Lay them out all looked at them
we agreed we were going to agree to disagree sometimes. And
recognize that that was okay.
And sometimes it was not going to be okay. So we knew that
upfront and said that upfront. We talked about what would this
even mean or our process and decided what we do know we need to
do? What to we need to do from Part C IDEA standpoint and
regulations in Maine for Early Intervention and what do we need
to do for deaf Early Intervention? So we pulled out the
statutes in Maine, we pulled out JCIH, which was really a guide
in process. We analyzed it up and down and really used that as
our guide.
And then, we decided we have to focus on what we have in common
and well what it was the desire to serve the families no matter
what though wanted to do ‑ ‑ the children and wanted to make
things easier for them. The role who is responsible first
contact with families? Who is responsible for writing the IFSP
and so on and so forth ‑ ‑ step by step.
We decided this was going to be our purpose, our purpose
statement to develop one family‑ centered Early Intervention
program for families who have deaf and hard of hearing children
in Maine. Sounds simple.
>> ROY FOWLER: So basically, each of our sites, we had one staff
member from ECFS assigned to each of our Early Intervention
teams.
And they became a fully integrated member that have the team.
At those weekly teaming meetings, ECFS staff member was there
fully participating.
We staffed children at those meetings. We talk about concerns,
we coach each other and provide strategies. We invite other
therapists and teachers from around the table to joint visits.
Karen's staff helped out with eligibility evaluations when
there's a hearing concern in particular. And also with IFSP
development so they are really part of the process from intake
through IFSP development. Karen's staff at ECFS is available to
act as that primary service provider as a full part the CDS
team. Able to act as consultant to the primary service provider
and also able to join other primary service providers on joint
visits into the home to provide support, provide strategies, and
work with not only the child and family, but also with the PSP.
>> KAREN HOPKINS: Some of the nitty‑ gritty in the MOU, but a
copy of the MOU up here if you want to grab it. Written last
March and rewritten now probably some changes, but the one we
are following right now if you want it afterwards.
>> ROY FOWLER: One thing we tackled with revel ‑ ‑ audiologists
and other referral sources. Working within those referrals
would come to Child Development Services first rather than to
ECFS. And that way, we could ensure we start our process and
then make sure ECFS gets pooled in as early as possible. This
took some education, other referral sources audiologist we still
have a few around the state to talk to. They are still
referring in the same manner, either to one or the other or
both. Or to other agencies.
And that required a lot of ‑ ‑ in turning that referral point
over it to us required a lot of trust on the part of ECFS. They
needed to trust when they passed along the referral to us we
could closed the loop delivering services to that child.
>> KAREN HOPKINS: Part of what we do is spent a lot of time
building a team of support. One thing we have added that's not
highlighted in that MOU in print, is any family that has ‑ ‑ I'm
sorry I am dripping ‑ ‑ as Roy said, these professionals are
embedded into the EI process Early Intervention process and
available to review and interpreter audiological evaluation and
what that's been helpful is in the years past, the CDS team
would get audiological they really didn't understand it.
Sometimes they might say this is a baby that might need some
support or not. So ‑ ‑ doing that as it comes in the door.
We are joining the service coordinator on the welcome visitors.
Multidisciplinary teams and completing the interviews and
embedded into that process. As part of this process what we
identify was the need to really solidify what we were doing and
making it statewide consistent. Making sure that no matter what
in you were in the top of Maine or west, east, no matter where
you were, families were getting the same information. We spent
time talking about it with the service coordinators and at the
state level and came up with the ideas over years of doing this
we figured it out takes families about four to eight visits to
really look through all of these things, all the communication
options, the technology option that come their way. And there's
a lot of push to get information out there ASAP day 1, but we
have found is when you do that on the very first visit, you are
jeopardizing the bonding with some families and we wanted to
slow the process down a little bit, but make sure we got
information out in a timely manner and look at families where
they were in the process and accepting some will move faster
than others, but ensuring we get the information to them in a
timely manner.
So any family in Maine that has a baby that's deaf and hard of
hearing, is going to work with an Early Childhood and Family
Services consultant either as primary service provider or a ‑ ‑
visit consult and the consult will always be with the other
provider. In years past we went separately and now together.
>> Part of what happens at the end of the are process after 4 or
5 visits after family explored or options write a communication
plan and using the CDC communication plan for that the whole
process has been evolved over a number of years and I don't
think will ever be finished. We should infer be finished,
because updated information comes and new information about
modalities and trying to stay as current as possible so always
looking for feedback and is making ensure the primary service
providers are all trained and getting the same information.
One aspect we do is have families write this themselves with
their own hands. Unless they need additional support. We found
that's really empowering to have families write their choices
themselves and they bring to the IFSP meeting.
And as part of the MOU, we have an understanding that MECDHH,
has the other standards to follow. We have a deaf mentor
program in Maine and that allows families to meet other deaf and
hard of hearing adults. Trained in the ‑ ‑ program so we have 18
deaf adults trained from a variety of modalities we now have
deaf adults to send out to families if they have questions about
their life, life experiences, have they lived their life and we
do that. The other part that we have the parent infant toddler
program.
We have changed that so it's much more focused on the whole
family. They still come to a program, but it's an eight‑ week
session. A lot of parents are working. So it's quicker and
like your signing up for Mommy and me swim class, but it's
parent infant toddler program. We have a speech language
pathologist ‑ ‑ all available for chats with the families to
see ‑ ‑ right now a lot of ‑ ‑ talk about routines, in homes and
their life.
>> ROY FOWLER: After we developed the MOU ‑ ‑ I'm sorry before
the MOU, there was a lot of fear and apprehension on both sides.
I think probably more on the side of ECFS.
Wondering how they could fit into the CDS team and if they did
fit in the CDS team were they going to be able to provide the
services they felt needed to be provided?
Would they be losing identity as ECFS by joining us? Would
families get what they needed? On the part of CDS here's the
new person we really don't know coming to sit down at weekly
meetings. We don't know who they are and what they can bring to
the table or what kind of resource. It was learning trying to
apprehensive about learning the new process.
After we put the MOU into place, there was some training CDS
provided to ECFS providers.
That included the routines‑ based Early Intervention that
included coaching; that included ‑ ‑ developmentally inventory.
First steps really getting to know each other. Just having the
ECFS staff present at CDS sites to socialize and to be there at
the table to be available for what Karen calls, coffee chats,
just so that everybody is comfort level rose a bit. And then
Karen and I spent time Visiting each other's programs and sites
to really talk to our staff about how we envision are the
rolling out what it means to us as CDS and ECFS staff. We
explain the MOU and if any of you have written an MOU they are
not always the most easy things to understand. Depending on who
wrote them, but we visited all CDS sites and I joined Karen and
our team for meetings.Ment.
>> KAREN HOPKINS: Kind of slow start, even though it's been a
year we gave both teams the permission to move slowly and take
the time to get to know each other. What started happening is
the CDS staff started realizing they had the additional person
there. And because they saw them every week they started
saying, maybe you could help me with this child. They would
start inviting them to joint visitors.
>> ROY FOWLER: So challenges for the pilot year interpreting the
MOU and responsibilities figuring out we have the MOU what does
it mean? Buy‑ in was slow to start with, but as gone on there's
been significant buy‑ in from both sides. We have been ‑ ‑ it's
gone off remarkably well. Both sides very comfortable with how
it's playing out. We have some challenges in under IDEA we have
45 days to get in and do the evaluation and write the plan is,
as opposed to Karen's side.
>> KAREN HOPKINS: Three days.
>> ROY FOWLER: The timeline is tighter.
>> KAREN HOPKINS: Really focusing on the need for Early
Intervention and support was our concern making sure the
families had the information need. We did a training and
approaches firmed up six visit process. We talked a lot about
core competencies and again, with the JCIH looked at the
attachments and all involved with that and made sure everyone
had a clear understanding of what that was the crux of it was
creating a family‑ centered team one team and joy and benefit the
family now had access to the full team of Early Intervention
specialists.
>> ROY FOWLER: This really MOU really helped lay the groundwork
for a functional respectful working relationship between all
parties. It hadn't existed before across the state ‑ ‑ now it
does exist across the state. Resulted in more appropriate
services for children who are deaf and hard of hearing. Such a
low instance, CDS wasn't able to have the folks ‑ ‑ only pulling
in people like ECFS to have regular access to people with
expertise and.
>> KAREN HOPKINS: What's next? Really branch out again look at
that six visit process looking at communication options
expiration process reaching out reaching out to deaf community
to the ASL teachers in the state to listening and spoken
language specialists and getting feedback and support and
modifying the process as needed. Again to we are updated.
We have a strong Guide By Your Side program as just started and
it's really taken off look at where that's going to fit within
this MOU and state process. Deaf Mentor program making sure
that's not forgotten. And Roy plans to emulate this MOU with
other entities throughout the state in general it's been very,
very positive and I would say as with most MOUs it's a work in
progress. We are identifying things on a regular basis we need
to tweak, but that's what's been really positive is that we're
constantly talking about what's working ask what's not working
and getting feedback from others and being open to feedback, I
think, is really critical. And I think that's it. We did it
with 30 seconds left. Any questions?
[ Applause ]
>> Thank you.
[End of session]
[ End of file ]
* * * * *
This is being provided in a roughdraft format. Communication
Access Realtime Translation (CART) or captioning are provided in
order to facilitate communication accessibility and may not be a
totally verbatim record of the proceedings
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