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'dxddd Level 1 Level 2 Level 3 Level 4 Level 5(q2U$ ,!    .T X.XT .T   ($ !"A<< c       &U)  .tZX.XtZ.tZ  _X¢XtZB.` hp x (#XB @ ddSG XX¢SX¢X G'XF XXX¢    B.X` hp x XB  5  'XF X X'XFX¢X X'XF    B.X` hp x XXBB  X¢XXX¢'XF XXX¢-  Error!MainDocumentOnly.-  USUS., C  'X  X'XFtZ 'X(q2U$ ,!    .T X.XT .T   *jp`*Bookman Old Style$35;?CGKOS11.1111111$35;?CGKOS2A.1111111$35;?CGKOS3a.1111111#|x(V$    .T X.XT .T 1A,,,,,,0(hH  Z6Times New Roman Regular.X3#37=CIQYag1.a.i.(1)(a)(i)1)a)s'ee6q9&U  &U)  8tZX.X9tZ.tZ  9X¢XtZB.` hp x (#XB @ ddS9G XX¢S9X¢X G:XF XXX¢    B.X` hp x XB  5  :XF X X'XF9X¢X X'XF    B.X` hp x XXBB  9X¢XXX¢:XF XXX¢-  Error!MainDocumentOnly.-  USUS., C  :X  X'XF9tZ 'X(hH  Z6Times New Roman Regular\  `&Times New Roman*jp`*Bookman Old Style Allenby OSEP IFSP S.W.&multidisciplinaryIFSPsBobbiStettner CDE"reauthorizationHehirIngelSafranekHarbour CFRtimelinesipayor ,!    .tZX.XtZ.tZ  _      X X¢XtZX¢XXX¢     -  #gWS~|@@Xxx<< dd@EHx<-  ԀUNITEDSTATESDEPARTMENTOFEDUCATION  ݌  ЌtZXX¢tZtZ   X¢XtZX¢XXX¢      ݌̌tZXX¢tZtZ   X¢XtZX¢XXX¢   t     ` {mXX¢OFFICEOFSPECIALEDUCATIONANDREHABILITATIVESERIVCESSERVICES t݌  ЌtZ{mtZtZ   X¢XtZX¢XXX¢     {mXX¢ I݌̌tZ{mtZtZ   X¢XtZX¢XXX¢     &c%XX¢Ԁ C݌ H ЌtZ%&ctZtZ   X¢XtZX¢XXX¢     &c%XX¢ԀJULY14,1999 T݌ $ ЌtZ%&ctZtZ   X¢XtZX¢XXX¢   Q  ݀ Q݌   ЌtZXX¢tZtZ  X¢XtZMr.CliffordAllenby   DirectorDepartmentofDevelopmentalServices1600NinthStreetSacramento,California95814DearMr.Allenby:DuringtheweekofJune15,1998,theOfficeofSpecialEducationPrograms(OSEP)oftheU.S.DepartmentofEducationconductedafocusedonsitemonitoringreviewoftheCaliforniaDepartmentofDevelopmentalServices(DDS)implementationofPartC,formerlyPartH,oftheIndividualswithDisabilitiesEducationAct(PartC).OSEP'smonitoringplacesstrongemphasisonthoserequirementsmostcloselyassociatedwithpositiveresultsforchildrenwithdisabilitiesandtheirfamilies.ThepurposeofthereviewwastodeterminewhetherDDSismeetingitsresponsibilitytoensurethatservicesforinfantsandtoddlerswithdisabilitiesandtheirfamiliesareadministeredinamannerconsistentwiththerequirementsofPartC,particularlywithregardtoDDS'exerciseofitsgeneralsupervisionresponsibilityandtheprovisionofearlyinterventionservices.OSEP'smonitoringrevealedthatDDSdoesnotensurecompliancewithallPartCrequirementsthroughouttheState.Asfurtherexplainedbelowandintheenclosedreport,OSEPfoundseriousdeficienciesregardingDDS'generalsupervisionofearlyinterventionservicestoeligiblechildrenandtheirfamilies.InOctober1993,theCaliforniaEarlyInterventionServicesAct(Title14,GovernmentCodeSection95000,  etseq.)waspassedtoenabletheStatetoimplementtheFederalrequirements 0  underPartCofIDEA.TheActrequiredatwoyearstatewideevaluationofCaliforniasEarlyStartProgramthatwascompletedinJuly1997undercontractwiththeAmericanInstituteforResearch.TheStatecommissionedEarlyStartProgramEvaluationReport,includingfindingsofnoncompliancewithPartCrequirementsandrecommendationsforimprovementoftheStatessystemforearlyintervention,wassubmittedtoOSEPintheSpringof1998,andassistedOSEPinplanningthefocusedmonitoringvisit.TheReportnotedmanyofthesamefindingsthatOSEPlateridentifiedinJune1998.InresponsetotheReport,theStateconvenedanEarlyStartWorkgroupinJuly1997toidentifyandprioritizeimpactareasrelatedto:1)theIndividualizedFamilyServicePlan(IFSP)process;2)modelsofservicedelivery;3)personnelstandards;4)monitoringandsupervision;5)transitionfromPartC;6)resolvinginteragencydisputes;7)fundingandadministration;8)FamilyResourceCenters;and9)childfindandreferral.However,OSEPisconcernedthattheStatedidnottakeimmediateactiontocorrectareasofnoncompliancewithPartCIDEA,asnotedintheReport.  0p+/ ^XX¢  400MARYLANDAVE.,S.W.WASHINGTON,D.C.20202 P   X¢X^ Page2Mr.CliffordAllenbyIdeeplyconcernedaboutthedeficienciesdescribedintheenclosedreportthatOSEPfoundregardingDDSfailureto:(1)monitoranyprovidersofearlyinterventionservicesotherthantheregionalcentersandtomonitorregardingtheprovisionofallservices;(2)ensurethata   comprehensive,multidisciplinaryevaluationandassessmentiscompletedforeacheligibleinfant   andtoddler;(3)ensurethatIFSPsthatmeettherequirementsof303.344arecompletedforeacheligibleinfantandtoddler;and(4)ensurethateligibleinfantsandtoddlersreceivetheearlyinterventionserviceswhichtheyneed,asdeterminedbytheIFSPteamandwithoutdelay.DDS `  musttakeimmediateandeffectivecorrectiveactiontoaddressthedeficienciesnotedinthisreportandtoensurecompliancewithallPartCrequirementsthroughouttheState.EnclosureAtothisletterdescribesOSEP'smonitoringmethodologyandcorrectiveactionproceduresandEnclosureBlistsseveralcommendableinitiativesundertakenbyDDS.OurfindingsandrequirementsforcorrectiveactionsareinEnclosureC.H4` hp x (#XHAttheexitmeeting,whichconcludedOSEP'sonsitevisit,membersoftheOSEPmonitoringteam,Ms.JacquelynTwiningMartin,Ms.RuthRyder,Mr.LarryRingerandDr.BobbiStettnerEaton,discussedthepreliminaryfindingswithyou,membersofyouradministrativestaff,andmembersoftheCaliforniaDepartmentofEducation(CDE)staff.TheOSEPteamhighlightedboththestrengthsofthesystemandconcernsregardingDDS'supervisionandadministrationoftheState'sPartCearlyinterventionsystem.K.` hp x (#XKIwouldliketothankyoufortheassistanceandthecooperationthatMr.Flores,thePartCCoordinatorforCaliforniaatthetimeofthevisit,hisstaff,andtheDDSandCDEcontractorsprovidedduringourreview.Throughoutthemonitoringprocess,thestaffwasveryresponsiveinprovidinginformationthatenabledOSEPstafftoacquireabetterunderstandingoftheimplementationofPartCinCalifornia.TheCommitteeReportthataccompaniedthe1997reauthorizationoftheIDEA,PublicLaw10517,underscoredtheimportanceofearlyinterventionservicesforinfantsandtoddlerswithdisabilitiesandreconfirmedourbeliefthatitisinthebestinterestofthesechildren,theirfamilies,schools,andsocietyingeneralthatservicescontinuetobeprovided.WethankyouforyoureffortstoimproveearlyinterventionservicesandresultsfortheyoungestofchildrenwithdisabilitiesinCalifornia.OurstaffisavailabletoprovidetechnicalassistanceduringanyphaseofthedevelopmentandimplementationofDDScorrectiveactions.Pleaseletmeknowifwecanbeoffurtherassistance.   `     h   Sincerely,̀ThomasHehir   `     h   Director  0p+/ Ѐ   `    OfficeofSpecialEducationPrograms   B.` ` hp x (#XB PEnclosures `    P B.` hp x (#` XBcc:Ms.JulieAnnJackson       `     h H4` hp x (#XH     `     h   ENCLOSUREA     K.` hp x (#XK OSEP'SMONITORINGMETHODOLOGY     Ӏ PresiteDocumentReview: AsinallStates,OSEPusedamultifacetedprocesstoreviewthe `  implementationofPartCinCalifornia.Inadditiontoonsitevisitstoearlyinterventionserviceproviders,thisprocessincludedreviewof:(1)theStatesPartCapplicationwhichsetsouttheStatesstatutesandregulations,policiesandprocedures,andinteragencyagreementsthatimpacttheprovisionofservicestoinfantsandtoddlerswithdisabilitiesandtheirfamilies;(2)theCaliforniaEarlyStartProgramEvaluationReport;(3)theStatesPartCannualperformancereport;(4)theStatesPartCTrainingandTechnicalAssistanceProgramReviewdocuments;and(5)othercorrespondence,andtelephonecallsthatOSEPreceivedregardingtheStatesimplementationofPartC.PriortoitsvisittoCalifornia,OSEPalsorequestedandreviewedadditionaldocumentationrelatedtotheStatesimplementationofrequirementsfordueprocesshearings,complaintresolution,andchildcountinformation. InvolvementofParentsandAdvocates: Duringtheonsitevisit,OSEPconductedsmallgroup  parentinterviewsinalloftheregionalcentersvisited.ParentsandadvocateswerealsoinvolvedintwofocusedoutreachmeetingsthatOSEPconvenedonthefirstdayofthemonitoringvisit.Ms.JacquelynTwiningMartin,Dr.BobbiStettnerEaton,andMr.LarryRingermetwith25invitedrepresentativesfromadvocacygroups,parents,providers,andStateandlocalagenciesinSacramento.Ms.RhondaIngelandMs.EllenSafranekmetwithrepresentativesofsimilarconstituenciesinAnaheim.Thepurposeofeachoftheoutreachmeetingswastosolicitcommentsfromtheparticipantsinresponsetofourquestions,whichguidedOSEP'sinquiryonthefocusedareasofthemonitoringvisit.OSEPalsoinvitedthegroupstoprovidewrittencommentsandtelephoneinputbasedupontheirexperienceswithCalifornia'simplementationofPartCoftheIDEA.$  @ $ $X $  %7B.` hp x (#XB SelectionofMonitoringIssuesandSitestoVisit: OSEPfocusesitscompliancereviewinall  StatesonFederalrequirementsthatarecloselyrelatedtoenhancedresultsforchildrenandtheirfamilies.ThoserequirementsincludeaneffectiveStatemonitoringsystemfortheidentification,andcorrectionofnoncompliance,includingtheuseofenforcementwhennecessary.OthercorerequirementsthatOSEPreviewedinCaliforniaincludedensuringthatalleligiblechildrenwithdisabilitiesreceivethetimelydevelopmentandimplementationofanIFSP.InformationthatOSEPobtainedfromitsreviewofrelevantStatedata,interviewswithStateofficialsandconsumers,reviewofStatedocumentsandthePartCTrainingandTechnicalAssistanceReport,assistedOSEPintheidentificationof:(1)programsandregionstobevisitedformonitoring;(2)targetedareasonwhichtofocusitsonsitereview;and(3)concernsandissuesfacedbyfamiliesandotherinterestedparticipantsrelatedtotheimplementationoftheearlyinterventionsysteminCalifornia.OSEPinterviewedDDSandCDEEarlyStartprogramliaisons,localprogramadministrators,andprovidersandotherEarlyStartmanagersthatDDSandCDEinvitedfromdesignatedregionalcenters/SpecialEducationLocalPlanningAreas.OSEPteamsinterviewedStateandlocalproviderexecutivestaff,andStateandlocalinteragencycollaborators,includingCDEandrepresentativesoftheStateInteragencyCoordinatingCouncilandreviewedrelevantdocumentation.TheteamsvisitedandcollectedimplementationdatafromearlyinterventionprogramsoperatedbyRegionalCentersandSpecialEducationLocalPlanningAreas.Ms.SarahWillis,Ms.RuthRyder,andMs.IngelvisitedandcollectedimplementationdataatprogramsitesinthesouthernpartoftheState.Ms.TwiningMartin,Ms.RyderandDr.StettnerEatonvisitedandcollectedadditionalimplementationdatainthenorth.Whereappropriate,OSEPhasincludedinEnclosureCdatathatitcollectedinthevisitstoprovidersthatsupportorclarifyitsfindings.OSEPhasnotusedthenameofanyoftheprovidersinEnclosureC;instead,theprovidersvisitedareidentifiedonlywithdesignationssuchas ProviderA.Akeytothesedesignationsisprovidedasfollows:Provider `     h      p Designation󀀀      `    SouthwestSpecialEducationPlanningArea     p ProviderA "  HarbourRegionalCenter   h      p ProviderB #! SanDiegoRegionalCenter   h      p ProviderC $" SanDiegoSpecialEducationPlanningArea     p ProviderD % # ValleyMountainRegionalCenter h      p ProviderE p&!$ SacramentoSpecialEducationPlanningArea   p ProviderF   x   `'"%   AltaRegionalCenter    h      p ProviderG @)$' ЇH4` hp x (#XHX¢XXX¢X¢XXX¢  ;  < p x (#X<;;݌̌$ XX$X¢XXX¢X¢XXX¢  H4` hp x (#XHX¢XXX¢X¢XXX¢  <  < p x (#X<EnclosureCoutlinesthegeneralcorrectiveactionsthatDDSmusttaketobeginimmediate  correctionofthefindingsintheEnclosure.InordertosupportthedevelopmentofamutuallyagreeablecorrectiveactionplanthatwillcorrectthefindingsinEnclosureCandimproveresultsforyoungchildrenwithdisabilities,OSEPproposesthatDDSrepresentativesconferwithOSEPstafftodiscussthefindingsandthemosteffectivemethodsforensuringcomplianceandimprovingservicesandresultsforinfantsandtoddlerswithdisabilitiesandtheirfamiliesintheState,andtoagreeuponspecificcorrectiveactions.WealsoinvitearepresentativefromtheCaliforniaInteragencyCoordinatingCounciltoparticipateinthatdiscussion.Thecorrectiveactionplanmustbedevelopedwithin45daysofreceiptofthisreport.ShouldDDSandOSEPfailtoreachagreementwithinthis45dayperiod,OSEPwillbeobligedtodevelopthecorrectiveactionplan.<9=݌̌$ XX$X¢XXX¢X¢XXX¢   @    B.` hp x (#XBX¢XXX¢X¢XXX¢    B       `     h ENCLOSUREBBB BԌ  Ќ   XXX¢XXX¢X¢XXX¢    COMMENDABLEINITIATIVES     H4` hp x (#XHOSEPidentifiedthefollowingcommendableDDSinitiativesaspartoftheonsitereview: C ( $31C ,T7` hp x (#XT 2  1  .3    FamilyResourceCenters/Networks. OSEPcommends DDSforitsleadershipin P  establishingasystemoffamilysupportservicesforCaliforniasfamilies!theFamily @  ResourceCenters/Networks.TheseCenterspromotecontinuousfamilycenteredservicesandareeffectiveingrassrootschildfindandreferralactivities.ThisStatewideinitiativeensuresongoingfamilysupportforyoungchildrenwithdisabilitiesandtheirfamiliesandcaretakerswithintheirlocalcommunities,andtherefore,assiststheformalservicesystemwithvitallinkagestoresourcesthatareavailableandaccessible.  @    ,T4` hp x (#XT ,Q4` hp x (#XQ %  2.  CulturalSensitivity. DDSandProviderAhavemadeconcertedeffortstoreachoutto   familieswhoareculturallyandlinguisticallydiverse.Awidearrayofpublicationsandotheruserfriendlymaterialsareavailableinmultiplelanguages,includingRussianandJapanese.PacketsofinformationabouttheIFSPprocessandparentsrightscontaininformationinSpanishandotherlanguages.    %     K.` hp x (#XKX¢XXX¢X¢XXX¢    TK  ,H4` hp x (#XHENCLOSURECTKL KԌ  Ќ  0XX0X¢XXX¢X¢XXX¢    FINDINGSANDREQUIREDFOLLOWUP     Inordertobeginimmediatecorrectionofthefollowingfindings,DDSmusttakethefollowinggeneralcorrectiveactions:1.DDSmustdisseminateOSEP'smonitoringreporttoallpublicagenciesandearlyinterventionprovidersanddirectthemtodeterminewhethertheyhavecompliedwithPartCrequirements,asclarifiedbythisdocument.DDSmustissueamemorandumtofurtherdirecttheseagenciesandproviderstodiscontinueanynoncompliantpracticesandimplementproceduresthatareconsistentwithPartC,andsubmitdocumentationtoDDSthattheyhaveimplementedrevisedproceduresthatcorrecttheciteddeficiencies.DDSmustsubmitthismemorandumtoOSEPforreviewwithin30daysofthedateofthisreport.Within15daysofOSEP'sapprovalofthememorandum,DDSmustdisseminateittoallagenciesandearlyinterventionprovidersthroughoutCalifornia;and2.DDSmustdevelopacorrectiveactionplan,inconjunctionwithOSEP,theCaliforniaInteragencyCouncilonEarlyIntervention,andotherappropriatepartners,toaddressthedeficienciesdetailedinthisreport.ThecorrectiveactionplanmustbedevelopedandsubmittedtothisOfficeforapprovalwithin45daysofDSSreceiptofthisreportand,uponOSEPsapproval,bedisseminatedwidelytoinformthepublicoftheactionsbeingtakentoaddressthefindings.Inaddition,DDSmustsendtoOSEPverificationthatthedeficiencieshavebeencorrected. Section1.EarlyInterventionServices   p Q4` hp x (#XQX¢XXX¢X¢XXX¢    S  C ) $$(C-- ,T7` hp x (#XT 2  A  .3    DeterminationofuniqueneedsthroughevaluationandassessmentSWT ?TԌ P Ќ3XX3X¢XXX¢X¢XXX¢   ,Q4` hp x (#XQ34CFR303.322requiresStatestoensuretheperformanceofatimely,comprehensive,multidisciplinaryevaluationofeachchild,birththroughage2,referredforevaluation,andassessmentactivitiesrelatedtoeacheligiblechildandthechild'sfamily.TheevaluationandassessmentprocessmustbebroadenoughtocapturecompleteinformationrequiredintheIFSPconcerning:(1)Thechild'spresentleveloffunctioningineachoffivedevelopmentalareas;and(2)thefamilysresources,priorities,andconcernsrelatedtothechildsdevelopment.Asrequiredby34CFR303.322(a)(1),eachevaluationmustbemultidisciplinary,which,asdefinedat303.17,meansanevaluationthatisconductedbytwoormoredisciplinesorprofessions.  X¢XXX¢X¢XXX¢   Z  Q4` hp x (#XQ ZkZ݌ `'"% ЌX¢XXX¢X¢XXX¢  & p  Finding1:Comprehensive,MultidisciplinaryEvaluationsandAssessmentsNotCompleted  forAllInfantsandToddlerswithDisabilities OSEPfindsthatCaliforniasPartCsystemdoesnotalways:(1)conductevaluationsand  assessmentstoidentifytheuniqueneedsofinfantsandtoddlerswithdisabilities(303.322(b));(2)completeevaluationsandinitialassessmentswithin45daysafteritreceivesthereferral(303.322(e);and(3)ensuremultidisciplinaryevaluationsareinaccordancewith(303.322(a)(1),303.17).'pR[ParticipantsintheOSEPfocusedoutreachmeetingsstatedthat:(1)providersarenotconductingcomprehensiveassessmentsorevaluations;(2)servicesaredeterminedpriortothecompletionoftheassessmentsinthefivedevelopmentaldomains;and(3)theRegionalCentersdetermineeligibilitywithoutcompletingtherequiredevaluationsinthefivedevelopmentalareas.Severalparticipantsalsoreportedthatevaluationsareoftenconductedbyoneperson,notamultidisciplinaryteamasrequired,andnotinallfiveareasofdevelopment,includingvisionandhearing.ServicecoordinatorsinProviderBtoldOSEPthattheydeveloptheinitialIFSPwithoutconductinganevaluationorassessments,andstated:"Youdon'tneedanassessmenttoknowwhatbabiesneed." Referralcomesfromahospitalandifthebabyhasasyndrome,wewon'tdoanassessment,"and"Ifwehaveadiagnosis,weknowwhattoexpectandwilldoevaluations/assessmentswithinsixmonths."TheEarlyStartProgramEvaluationReportstatesthat,"somechildrenarebeingevaluatedforeligibilityandarereceivingservicesindefinitelywithoutacomprehensiveassessmentintherequiredfivedevelopmentalareas."OSEPalsofoundthroughrecordreviewandinterviews,thatvisionandhearingevaluationsandassessmentswereconductedinProvidersA,B,andConlyforinfantsandtoddlerswithpreviouslydocumentedsensorydeficits.Inaddition,areviewofchildrensrecordsinProvidersA,B,andCindicatedthat,whiletheinitialmeetingtodeveloptheIFSPoccurredwithin45daysfromthedateofreferral,therequiredevaluationsandassessmentshadnotbeencompletedwithintherequiredtimeperiod.OSEPfoundthatwhereevaluationsandassessmentshadnotbeencompleted,providersincludedstatementsinIFSPssuchas"continuetopursueevaluationsor willbeevaluatedforfunctioninglevels/recommendationsastoservicesneeded."Noneoftherecordsincludeddocumentationofexceptionalcircumstancesthatmadeitimpossibletocompletetheevaluationsandassessmentswithin45days.  p&!$ &   OSEP'sreviewofrecordsinProvidersBandCalsoconfirmedthepracticedescribedintheStatecommissionedEarlyStartProgramEvaluationReport,thatevaluationsandassessmentsarenotmultidisciplinary.SeveralrecordsOSEPreviewedindicatedthatonlyonediscipline(e.g.,occupationaltherapyorphysicaltherapy)completedtheentireevaluationandassessmentforsomechildren,ratherthanatleasttwodisciplines,asrequiredby34CFR303.17and303.322(a)(1). X¢XXX¢X¢XXX¢   h  Q4` hp x (#XQ''f hvh݌̌X¢XXX¢X¢XXX¢    & ` Ԁ B. DevelopmentoftheIFSP  @  PartCemphasizestheinherentroleoffamiliesasthedrivingforceintheidentificationoftheirstrengthsandneeds,aswellasthoseservicesrequiredtoenhancethedevelopmentoftheirchild.ThedevelopmentofanIFSPisaplanningprocessthatsupportsandbuildsonthefamilyscapacitytoenhancethedevelopmentoftheirchildandpromotesfamiliesandprovidersworkingtogethertoidentifyandmobilizeformalandinformalcommunityresources.Thisprocessfacilitatesongoingopportunitiestoexpandcommunityrelationshipsandacommonknowledge   baseaboutindividualchildneedsandstrengths.'` @ hi34CFR303.344requiresStatestoensurethateacheligibleinfantortoddlerhasanIFSPthatcontainsspecificinformationaboutthechild'spresentlevelsofdevelopment,theoutcomesexpectedtobeachievedforthechildandthechildsfamily,andthecriteria,procedures,andtimelinesusedtodetermineprogress.TheIFSPmustalsoincludeastatementofthespecificearlyinterventionservicesnecessarytomeettheuniqueneedsofthechildandthefamilytoachievetheoutcomesandindicate:(1)thefrequency,intensity,andmethod;(2)thenaturalenvironmentsinwhichtheserviceswillbeprovided;and(3)thepaymentarrangements.EachIFSPmustbeimplementedassoonaspossibleaftertheIFSPmeetingandcontaintheprojecteddatesforinitiationoftheearlyinterventionservices(303.344(f)). Finding2: IFSPsdonotIncludeAllRequiredComponents  P Asdiscussedbelow,OSEPfindsthatDDShasnotensuredthatIFSPsincludeallrequiredcontent.Q4` hp x (#XQX¢XXX¢X¢XXX¢  Dp  TheEarlyStartProgramEvaluationReportdocumentsconcernsregardingthevariabilityinthe "  contentoftheIFSPacrosstheState.TheReportshowsthattheextenttowhichIFSPscontainedallrequiredcomponentswasnotconsistentfromregiontoregionandconcludedthattheadequacyofthecontentwasoftendeterminedbythedesignoftheIFSPformusedbylocalproviders.TheReportalsonotesthatIFSPswerelesscomprehensiveforchildrenandfamiliesforwhomEnglishwasasecondlanguage.Dpp݌̌0XX0X¢XXX¢X¢XXX¢  AreviewofDDSmonitoringreportsindicatedthattheDDShadidentifiedconcernsregarding @)$' IFSPformatsinProviderAandProviderBbecausealloftherequiredcomponentswerenotontheforms.OSEPexaminedrevisedIFSPformsinProviderAandBduringthismonitoringtripandfoundthattheycontinuetolackrequiredcomponentsandinstructionsforproviders.  Furthermore,inProviderA,OSEPreviewedcompletedIFSPsandfoundthattheyalllacked:(1)presentlevelsoffunctioning;(2)familyconcerns,priorities,andresources;(3)duration;(4)location;and(5)alistoftheearlyinterventionservicestobeprovidedtothechild.InProviderB,thecompletedIFSPsthatOSEPreviewedincludedlistedservices,strategiesandactivitiesconsistentwith303.344(c) , butdidnotincludethelocationormethodasrequiredby 0  303.344(d)(i)and(iii).NoneofthecompletedIFSPsreviewedinProvidersA,B,C,andDincludedrequiredinformationrelatingtotheprovisionofearlyinterventionservicesinnaturalenvironments,asrequiredunder303.344(d)(ii).Q4` hp x (#XQX¢XXX¢X¢XXX¢    =x  =xx xԌ̌0XX0X¢XXX¢X¢XXX¢   Q4` hp x (#XQX¢XXX¢X¢XXX¢    y  C ) $$)C-- ,T7` hp x (#XT 2  C  .3    BarrierstoImplementationoftheIFSPyz lzԌ 0  Ќ3XX3X¢XXX¢X¢XXX¢   ,K.` hp x (#XKH4` hp x (#XH34CFR303.340303.346requiretheLeadAgencytoensurethattheservicesforeacheligiblechildaredeterminedbytheIFSPteam,basedonevaluationsandassessmentsconductedbyamultidisciplinaryteamofqualifiedproviders. 34CFR303.344(f),303.520(c),and303.525requireDDStoensurethat:(1)thoseearly  interventionservicestowhichtheparenthasconsentedareprovidedassoonaspossibleaftertheIFSPiscompleted;and(2)noservicetowhichanindividualchildisentitledisdelayedordeniedbecauseofdisputesbetweenagenciesregardingfinancialresponsibilities.34CFR303.527(b)requiresStatestoensurethatPartCfundsarenotusedtopayforserviceswhicharethefiscalresponsibilityofotherpublicorprivatesources.WhilePartCisthepayoroflastresort,303.527(b)(1)providesthatPartCfundsmaybeusedtopaytheproviderofservices,ifnecessarytopreventadelayinthetimelyprovisionofservicestoaneligiblechildorthechildsfamily,pendingreimbursementfromtheagencyorentitythathasultimateresponsibilityforthepayment.Asexplainedbelowinfindings3and4,themannerinwhichtheregionalcentersusepurchaseofservicecommitteesresultsin:(1)infantsandtoddlerswithdisabilitiesandtheirfamiliesnotreceivingtheservicestheyneed,asdeterminedbytheIFSPteam;and(2)illegaldelaysinthe #! provisionofservicessetforthinIFSPs.Q4` hp x (#XQX¢XXX¢X¢XXX¢   T  Finding3:EarlyInterventionServicesDeterminedbythePurchaseofServiceCommittee, p&!$ ratherthantheIFSPTeamT݌̌0XX0X¢XXX¢X¢XXX¢  Administrators,servicecoordinators,andindividualserviceprovidersinfiveoftheseven @)$' providersvisited,informedOSEPthatpurchaseofservicecommittees,ratherthantheIFSPteam,determinetheserviceseachchildandfamilywillreceive.Purchaseofservicecommittees,partoftheregionalcentersadministrativestructures,functionasthefinancialreviewteamintheareaofservicerequestsandoperateoutsidetheIFSPprocess.K.` hp x (#XKOSEPreviewedproceduresusedbytheregionalcenterstoimplementPartCrequirements,withafocusonproceduresforprovidingIFSPservices.OSEPfoundthefollowinginconsistencieswithPartCrequirements:(1)ProviderCspurchaseofserviceformindicatesthattheactualapprovalofservicesisbasedontheavailabilityoffunds(ratherthanontheuniqueneedsofthe  p  infantortoddler);and(2)ProviderGsprocedurestatesthatfundingforavendorserviceisdiscontinuedifthechilddoesnotmakeprogress,andasaresulttheserviceidentifiedontheIFSPisnolongerprovided(withoutanIFSPteamdeterminationthattheserviceisnolongerneeded).AdministratorsinProvidersA,B,CandF,andserviceprovidersinProvidersA,C,andE,toldOSEPthattheIFSPteamdoesnothaveultimateauthoritytodetermineservicesforeachchildandfamily.TheyinformedOSEPthateachregionalcenterspurchaseofservicecommitteeineachoftheprovidersapproves,deniesorreducesservicesthatareidentifiedintheIFSPforsomechildren.AserviceproviderinProviderCreportedthatregionalcenterserviceguidelinesareusedtodetermineifandhowoftenserviceswillbeprovidedratherthandecisionsmadebytheIFSPteamasrequiredbylaw.Corestaffonpurchaseofservicecommitteesmeettwiceamonthtoapprove,defer,denyorreducerecommendedservices.InProviderB,servicesandsupportsmaybepurchasedforaconsumeronlywhenithasbeendeterminedbythepurchaseofservicecommittee(ratherthananIFSPteam),thatsuchserviceswillaccomplishall,oranypart,ofachildsIFSP.InProviderF,anadministratortoldOSEPthatthepurchaseofservicecommitteeoperatesasadecisionmakingbodybetweentheIFSPmeetingwhereservicesareinitiallyidentified,andtheapprovalforpayment,andconfirmedthatparentsdonotattendpurchaseofservicecommitteemeetings.H4` hp x (#XHUnderPartC,theIFSPteammustincludeparents,qualifiedproviderswhohaveevaluatedandassessedthechild,otherserviceproviders,andtheservicecoordinator.34CFR303.343.Bylaw,theseindividualsarethedecisionmakinggroupwiththeresponsibilityandauthoritytodeterminetheservicesneededtomeetthoseneedsatthatpointintimebaseduponevaluationandassessment.ThedecisionsregardingtheearlyinterventionservicestobeprovidedtoaninfantortoddlerwithdisabilitiesandhisorherfamilymaybemadeonlybytheIFSPteam.DatasupportingthisStatewideissuearealsodocumentedintheEarlyStartProgramEvaluationReport.TheregionalcenterspurchaseofservicescommitteesuseanauthorizationprocedurethateffectivelyreplacesIFSPteamdecisionswhicharebasedonindividualizedneeds. Basedon @)$' dataobtainedfromparentinterviews,writtencorrespondencefromadvocates,telephonecommunicationsandcomplaintsreceivedbyOSEP,OSEPfoundthatIFSPteamsdonotmeetagain,afterpurchaseofservicecommitteesdenyorreduceservicesinitiallyidentifiedbyIFSPteams.Administrators,serviceproviders,andparentsinProvidersBandCinformedOSEPthatsomeinfantsandtoddlerswithdisabilitiesdonotreceivealloftheservicesthattheyneed,asdeterminedbytheIFSPteam,becausethepurchaseofservicecommitteedeniesorreducesservicessetforthintheIFSP.&  Finding4:DelayintheProvisionofEarlyInterventionServices  0  '0 &Q4` hp x (#XQX¢XXX¢X¢XXX¢    Asdiscussedbelow,OSEPfindsthatbecausethereisnoappropriatepaymentorreimbursement `  proceduretoensurethatchildrenreceiveservicesinatimelymanner,theprovisionofearlyinterventionservicestosomechildrenandfamiliesisinappropriatelydelayed.M݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢    & @ InCalifornia,theregionalcenterscontractwithlocalpublicandprivatevendorsfortheprovision   ofthemajorityofearlyinterventionservices.Theregionalcentersareresponsibleforservicecoordinationandevaluationandassessment.RegionalcentersarechargedbyDDSwithlookingfirstatoutsidepaymentsourcesforearlyinterventionservicesbeforeusingStatefundsandthencoordinatingserviceprovisionsupportedbyeffectivefundingmechanisms.Sincethemajorityofservicesforeligibleinfantsandtoddlersareprovidedthoughcontractwithprivateproviders,thesmoothoperationofthefundingsystemwithrespecttopotentialresourcesisessential.InaJuly1996lettertotheStateofPennsylvania,OSEPstatedthatStatesmightestablishpriorauthorizationforcertainservices,costs,orothercomponentsintheprovisionofearlyinterventionservicesundercertaincircumstances,butthattheuseofpriorauthorizationprocedurescannotresultinviolationsofPartCrequirements,includingdelaysinservices.Ș݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢    '@ ]݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢  "  IntheEarlyStartProgramEvaluationReport,parentsresponsestoafamilysurveyexpressed ` frustrationwiththepracticeofrequiringprivateinsurancedenialorapprovalforfundingfromanotheragencybeforeservicescouldbegin.TheReportstatesthatfamiliesreportedanaveragewaitofoverthreeweeksforservicestostartaftertheinitialIFSPmeeting,witharangeof0to24weeks.Thestudydidnotexaminetheextenttowhichdelaysinserviceswereoccurringorthespecificbarrierstobeginningservices assoonaspossibleafteranIFSPmeetinginaccordancewith303.344(f).However,theReportrecommendedthisareaforinvestigationbytheState."̟݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢  A  A݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢    TwoofthequestionsOSEPaskedduringthefocusedoutreachmeetingsonJune15,1998were, % #  Dosourcesofpaymentimpacttimelydeliveryofearlyinterventionservices?and Aresomeservicesdelayedorevendeniedtochildrenortheirfamiliesbecauseofthesepaymentissues?Participantsinthefocusedoutreachmeetingsstatedthattherewasnomechanismtosecurereimbursementatthelocallevel,thusdelayingthetimelyprovisionofservices.Aparticipantin @)$' theoutreachmeetingssummarizedpaymentissuesbystatingthat"Noagencyismotivatedtostepin,useotherfundsintheinterim,beforeservicesareprovided."Meetingparticipantsdescribednotonlydelays,butalsodenialsofneededserviceswhenthereweredisputesoverwhichagencywasfiscallyresponsibleforaservice.OutreachmeetingparticipantsalsoreportedthatthepayoroflastresortprovisionofPartCisoftenanimpedimenttoservicedeliverybecauseoftheStateslackofareimbursementmechanism.ThisimpedimenttoservicedeliveryresultsineligibleG݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢  P  P݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢    childrenandtheirfamiliesinCalifornialiterallywaitinguntilapayorisidentifiedbefore 0  providingearlyinterventionservices,howeverlongittakes.V݌̌0XX0X¢XXX¢X¢XXX¢  6 (#X6ParticipantsattheOSEPoutreachmeetingsreportedthatdelaysofthreemonthsormoreoccur,whileawaitingthepurchaseofservicecommitteesdecisiontopayforaparticularservice(s)listedonchildrensIFSP.AcrossthesevensitesthatOSEPvisited,interviewswithadministrators,localserviceproviders,parents,andservicecoordinators,confirmedthatitwascommonpracticefortheregionalcentertoobtainpurchaseofservicecommitteeand/orwrittenprivateinsurancedenialorapprovalforfundingbeforefinalizingtheIFSPorinitiatingservices,  withanaveragedelayofthreemonthsinprovidingservicestoeligiblechildrenandfamilies.Providersalsoexpressedconcernsoverdelaysingettingservicesstartedduetopaymentapprovalprocedures.W4` hp x (# XWX¢XXX¢X¢XXX¢    ϱ݌̌6 XX6X¢XXX¢X¢XXX¢  OSEPlearnedininterviewswithregionaladministratorsandservicecoordinators,andreviewsof ` IFSPsinProvidersAandB,thatfamiliesexperiencesignificantdelaysintheprovisionofservices,waitingforapprovalofapaymentsource(s).UnderPartC,disputesoverpaymentorotherissuesmustnotcauseinterruptionsordelaysintheprovisionofentitledservices.AnadministratorinProviderAtoldOSEPthatinfantsandtoddlerswaitlongerthan45daysforassistivetechnologydevices,suchashearingaids,whiletheagencyisattemptingtoobtainafundingsource.W4` hp x (# XWX¢XXX¢X¢XXX¢    Inanefforttobetterunderstandthisissue,OSEPreviewedadraftofProviderC'slocal 0 interagencyagreement,inadditiontoconductinginterviewswithparents,servicecoordinators,providersandadvocates.ProviderC'sagreementstatesthatregionalcentersarethepayoroflastresortafterallotherpublicandprivatesourceshavebeenreviewedtodetermineifareferralneedstomadetoanotherpaymentsource.Theagreementalsostatesthatreferralsmayinclude,butnotbelimitedtoCaliforniaChildrensServices,orprivateinsuranceprovidersthatmayhaveresponsibilityforpayment.Whiletheagreementincludesproceduresthatmaybeusedtosecurefundingresourcesoutsideoftheearlyinterventionsystem,aspermittedunderPartC,itdoesnotaddresstherequirementthatservicesnotbedelayed.݌̌6 XX6X¢XXX¢X¢XXX¢  AnadministratorinProviderCinformedOSEPthatallgeneric(e.g.,Medicaid,private @)$' insurance)paymentsourcesmustbeexhaustedbeforethepurchaseofservicecommitteewillapproveservices.AservicecoordinatorinProviderCtoldOSEPthatshesubmitsthepurchaseofservicerequesttohersupervisor,whotakesittothepurchaseofservicescommittee,whoapproves,defersordeniestherequest.Thisprocessresultsindelaysofservicesanywherefromthreetosixmonths.W4` hp x (# XWX¢XXX¢X¢XXX¢    & ` OSEPlearnedfromanadministratorinProviderDthatapprovaldecisionsfromtheregional P  centeroftenresultindelaysorreductioninserviceprovision.TheadministratorinformedOSEPthattheapprovalprocessforpaymentfromtheregionalcenterforservicesonanIFSPoftenresultsindelaysorreductioninthefrequencyorintensityofserviceprovisionfromwhatwasdecidedbytheIFSPteam.AnadministratorinProviderCinformedOSEPthatthepurchaseofservicecommittee,asrequiredbytheregionalcenter,mustexhaustallgenericpaymentsourcesbeforeapprovingservicesregardlessofthelengthoftimeinvolved.Asaresultofthisinadequatereimbursementmechanism,theprovisionofneededservicestoeligibleinfantsandtoddlersandtheirfamiliesaredelayed.F݌̌6 XX6X¢XXX¢X¢XXX¢  W4` hp x (# XWX¢XXX¢X¢XXX¢  6  '` P e6݌̌6 XX6X¢XXX¢X¢XXX¢  SectionII.StateGeneralAdministrationandSupervision   34CFR303.501requiresthatallprogramsandactivitiesusedtoimplementthestatewideearlyinterventionsystemareconsistentwithPartCofIDEA,regardlessofwhethertheentityreceivesPartCfunds.EachStateisrequiredtoadoptandusepropermethodsofadministeringtheprogram,including:(1)monitoringagencies,institutionsandorganizationsusedbytheStatetoprovideearlyinterventionservices;(2)enforcingthePartCobligationsimposedonthoseentities;(3)providingtechnicalassistanceifnecessary;and(4)correctingdeficienciesthatareidentifiedthroughmonitoring.Aspartofitsgeneralsupervisionresponsibility,theStateleadagencymustensurethatallpolicies(e.g.,Statestatutes,regulations,Governor'sorder,directives,orotherwrittendocumentsthatrepresenttheState'spositiononthisprogram(see34CFR303.20)areconsistentwith34CFRPart303.W4` hp x (# XWX¢XXX¢X¢XXX¢     Finding5:DDSHasNotImplementedaMonitoringSystemtoIdentifyandEnsurethe 0 CorrectionofNoncomplianceQ݌̌6 XX6X¢XXX¢X¢XXX¢  Asdiscussedbelow,DDShasnotfulfilleditsobligationforthegeneralsupervision,administration,andmonitoringofprogramsandactivitiesusedbytheState,whetherornottheyreceiveassistanceunderPartCtoimplementtheStatewidesystemofearlyinterventionservices.OSEPfoundthatDDSdoesnot:(a)monitortoensurethatallprovidersofPartCservicesmeetPartCrequirements;and(b)ensurecorrectionwhereitidentifiesnoncompliance.W4` hp x (# XWX¢XXX¢X¢XXX¢   Z  C * $$)C-- ,T7` hp x (#XT 2  a  .3    DDSisNotMonitoringtoEnsureThatAllProvidersofPartCServicesMeetPartC P(#& RequirementsZ ݌ @)$' Ќ9 XX9X¢XXX¢X¢XXX¢   X¢XXX¢X¢XXX¢     ,W4` hp x (# XW ݌̌X¢XXX¢X¢XXX¢  OSEPlearnedfromStatemonitoringreportsandinterviewswithDDSstaffandproviders,that  DDSonlymonitorsitsregionalcenters,andthatneitherDDSnortheregionalcentersmonitortheirlocalcontractedvendorsforimplementationofPartCrequirements.Californias21regionalcenterscontractwithlocalvendorstoprovidedirectearlyinterventionservicessuchasoccupationaltherapy,speechtherapy,nursing,familytraining,counselingandhomevisits,andnutritionfornearly17,000childrenandtheirfamilieswhowerereceivingPartCservicesasofDecember1,1997.Regionalcentersdonot,inmostcases,providedirectearlyinterventionprogramsorservices.Therefore,whenDDSmonitorsitsearlyinterventionsystem,itonlymonitorstheregionalcenters(whichenablesDDStomonitoronlyforservicecoordination,evaluationandassessment,andfiscalissues),andarandomselectionofIFSPsformeetingcontentrequirementsunder303.344.BecauseDDSdoesnotmonitortheorganizationsthatprovidedirectservices,DDSisnotabletodeterminethroughitsmonitoringwhetherservicesareprovidedconsistentwithPartC.Q4` hp x (#XQX¢XXX¢X¢XXX¢  h  h݌̌0XX0X¢XXX¢X¢XXX¢  Q4` hp x (#XQX¢XXX¢X¢XXX¢    ParentsandadvocatestoldOSEPinoutreachmeetingsthatDDShasnotusedeffectivemethods  ofsupervisingandmonitoringitsproviderstoensurethatearlyinterventionservicesareprovidedinatimelymanner.DDSstaffconfirmedthatelementsofthecurrentmonitoringsystemarenotsufficientlysensitiveorcomprehensivetoidentifydeficiencies,andthatmonitoringmethodsandproceduresforfollowupondeficienciescouldbeimproved.n݌̌0XX0X¢XXX¢X¢XXX¢   X¢XXX¢X¢XXX¢     Q4` hp x (#XQ b.IneffectiveMethodsofCorrection M݌ ` ЌX¢XXX¢X¢XXX¢  OSEPfoundsomeoftheidentifieddeficiencieshadnotbeencorrected.Thus,DDSdidnotfollowupadequatelywiththeregionalcenterstodetermineifviolationsofPartChadbeencorrected.Priortothismonitoringvisit,OSEPreviewedthemostrecentDDSmonitoringreports,( TrainingandTechnicalAssistanceReport),dated1996and1997,fromeachoftheregionalcenters/SpecialEducationPlanningAreasOSEPvisited.Basedonthisreview,OSEPfoundthatProviderBdidnotcorrectDDSfindingsofmissingIFSPcontent,suchasfrequencyandintensityofservices,outcomesandmethods,anddelaysinserviceprovisionduetopersonnelshortages. InProviderA,DDSfoundthatIFSPsdidnotincludepresentlevelsofperformance "  thataddressallfivedevelopmentalareas,familyassessmentinformation,childshealthanddevelopmentinformation,andatransitionplan,althoughDDShadearliermadethesamefinding.OSEPreviewedcompletedIFSPsinProvidersA,B,andC,andfoundthat,notwithstandingDDSearlierfindingsofnoncomplianceregardingtheserequirements,theyalllacked:(1)presentlevelsoffunctioning;(2)familyconcerns,priorities,andresources;(3)duration;(4)location;and(5)alistoftheearlyinterventionservicestobeprovidedtothechild.DDShadalsofoundthatProvidersAandCdidnotconductmultidisciplinaryevaluationand @)$' assessmentsinthefivedevelopmentalareas.AsdiscussedinFinding1inSectionIofthisReport,OSEPfoundthattheseprovidershadnotcorrectedthisdeficiencybythetimeofOSEPsJune1998visit.  K.` hp x (#XK