Funding Early Childhood Systems of Care. Leadership Development Institute December 3-6, 2017

Transcription

1 Funding Early Childhood Systems of Care Leadership Development Institute December 3-6, 2017

2 Topics Demographics Emergent Trends Strategic Finance

3 Demographics

4 Average Age at Referral United States 17.8 months 17.8 months Average Length of Time in Program United States 15.5 months 15 months 13.2 months

5 Percentage of Children Served

6 Planned and Delivered IFSP Service Hours 8 Planned Delivered

7 Personnel Shortages 90.00% 80.00% 70.00% 80.95% 69.05% 76.19% 60.00% 50.00% 45.24% 40.00% 30.00% 20.00% 10.00% 21.43% 28.57% 9.52% 9.52% 14.29% 7.14% 23.81% 23.81% 0.00%

8 $ Early Intervention Funding $4,000,000,000 $3,500,000,000 Revenue $3,000,000,000 $2,500,000,000 $2,000,000,000 $1,500,000,000 $1,000,000,000 $115,608,698 $203,419,918 $459,224,922 $705,252,235 $827,626,828 All Other Funds State Special Education Private Insurance Part B 611 Local Education Agency County Tax Levy Part C Medicaid State General Funds State Part C Appropriation $500,000,000 $960,157,929

9 Cost Per Child Total reported funding per child: $7,744 Range: $1,405 to $52,700 * Based on revenue reported by states on 2016 ITCA Finance Survey

10 Stressors 80% 70% 67% 60% 50% 52% 54% 40% 30% 20% 10% 0% Insufficient System Funding Lack of Service Providers Lack of Staffing at Lead Agency

11 Emergent Trends

12 Trends with Impact Developmental Screening Initiatives Autism Identification Adverse Childhood Experiences Neonatal Abstinence Syndrome (NAS) Impact on Foster System and Early Intervention

13 Developmental Screening Initiatives

14 Parents greater than 200% FPL 22% Parents less than 200% FPL 31% Parental Concerns about Development All Parents 26% 0% 5% 10% 15% 20% 25% 30% 35%

15 Affordable Care Act Periodicity Requirements Developmental Screenings 9, 18 and 30 months Autism Screening: 18 and 24 months Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons. Developmental Screening

16 Learn the Signs, Act Early CDC Initiative Home Visiting Initiatives Early Intervention MCH Priorities Developmental Screening

17 Autism

18 Autism and Developmental Disabilities Monitoring Network

19 CDC Estimates in 68 children in the United States have autism Boys: 1 in 42 Girls: 1 in % increase from 1 in 88 reported in 2008 More than double the 1 in 150 reported in 2000

20 Adverse Childhood Experiences (ACES)

21 Definition Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being ACEs include: Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Substance Misuse in Household Domestic Violence Household Mental Illness Economic Hardship Parental Separation or Divorce Parental Incarceration

22 Key Points Economic Hardship is the most common adverse childhood experience Prevalence increases with child s age Abuse of drugs/alcohol, neighborhood violence and occurrence of mental illness most commonly reported 46% of children in the U.S. have experienced at least one ACE

23 Children Aged Birth to 17: Percentage having had zero, 1 or 2, or 3+ ACEs Zero experiences: 54% 1 or 2 experiences: 35% 3+ experiences: 11% Four most common ACEs: Economic Hardship: 26% Divorce:20% Alcohol/Drugs: 11% Violence and Mental Illness: 9%

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26 Program or System Do you look at Part C/Early Childhood Special Education through a programmatic lens or through a system lens?

27 How do we traditionally approach funding and programming? Program by Program

28 Early Childhood Systems Early Childhood Systems Working Group

29 Common Interest Program B Program A Child and Family Program C

30 Building the Plane While Flying It

31 Identifying Opportunities CSPD Family Training Data Systems Monitoring Administration Title V CCDF TANF Mental Health Head Start Direct Services

32 Phase I: Developing a Plan Demographics What are the existing child eligibilities? What children are likely to be eligible for which resources? Where are the children? Fiscal Resources Political Context Fund Source identification Fund source requirements What can each pay for Competing Priorities Anticipated political changes Existing Resources

33 Phase II: Planning Structure Demographic Data Fiscal Resource Data Context Data Finance and Data System

34 34 Essential Data Elements Data Category Data Elements Data Location Child & Family Demographics Service Data Child Name Diagnosis (ICD9/10) Program Eligibilities Family Income Primary Home Language Insurance Eligibilities Frequency/Intensity of Services Authorized Frequency/Intensity of Services Delivered Type of Service Date of Service Child Record Individualized Family Service Plan Clinical/Billing Records Program Data Charges by Service Billed Revenue (Reimbursement) Received by Source Billings Codes (ICD-9, CPT, HCPC) Local Provider Agency Fiscal records Lead Agency Data Staff Administrative Costs Infrastructure Obligations and Payments State Lead Agency Fiscal Records

35 Phase III: Administrative Activities Policies and Procedures Infrastructure Agreements Applications

36 Phase 4: Ongoing Monitoring Changing Demographics Changing Political & Economic Context New Interagency Agreements New Funding Sources Revised Policies Increased Support and Guidance

37 37 A Framework for Developing and Sustaining a Part C Finance System Phase I Phase III V I Demographic Information Phase II Agreements for Use of Resources Phase IV System Monitoring S I Fiscal Resources Design a Finance System Infrastructure O N Political and Economic Context Policies and Procedures Guidance and Support

38 FINANCING IS ALL ABOUT BUILDING RELATIONSHIPS

39 State Collaborations Frequently cited state collaborations and/or influences include, but are certainly not limited to, the following: Perinatal Substance Use providers Universal Newborn Hearing Screening Maternal Infant Early Childhood Home Visiting WIC State Departments of Early Education and Care State Department of Elementary and Secondary Education State Chapter of the American Academy of Pediatrics Adverse Childhood Experiences (ACEs) research

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