Funding Early Childhood Systems of Care Leadership Development Institute December 3-6, 2017
Topics Demographics Emergent Trends Strategic Finance
Demographics
Average Age at Referral 2016 2017 United States 17.8 months 17.8 months Average Length of Time in Program 2015 2016 2017 United States 15.5 months 15 months 13.2 months
Percentage of Children Served 3.5 3 2.5 2 2.4 2.43 2.53 2.66 2.67 2.82 2.78 2.77 2.82 2.95 3 1.5 1 0.5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Planned and Delivered IFSP Service Hours 8 Planned Delivered 7 6.7 6 6 5 4 4.5 5 4.4 4 4 5 4.3 4.8 4 3 2 1 0 2012 2013 2014 2015 2016 2017
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%
$0 2016 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
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
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
Emergent Trends
Trends with Impact Developmental Screening Initiatives Autism Identification Adverse Childhood Experiences Neonatal Abstinence Syndrome (NAS) Impact on Foster System and Early Intervention
Developmental Screening Initiatives
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%
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
Learn the Signs, Act Early CDC Initiative Home Visiting Initiatives Early Intervention MCH Priorities Developmental Screening
Autism
Autism and Developmental Disabilities Monitoring Network
CDC Estimates 1 2 3 1 in 68 children in the United States have autism Boys: 1 in 42 Girls: 1 in 189 30% increase from 1 in 88 reported in 2008 More than double the 1 in 150 reported in 2000
Adverse Childhood Experiences (ACES)
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
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
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%
Program or System Do you look at Part C/Early Childhood Special Education through a programmatic lens or through a system lens?
How do we traditionally approach funding and programming? Program by Program
Early Childhood Systems Early Childhood Systems Working Group
Common Interest Program B Program A Child and Family Program C
Building the Plane While Flying It
Identifying Opportunities CSPD Family Training Data Systems Monitoring Administration Title V CCDF TANF Mental Health Head Start Direct Services
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
Phase II: Planning Structure Demographic Data Fiscal Resource Data Context Data Finance and Data System
34 Essential Data Elements http://dasycenter.org/understanding-and-using-fiscal-data-a-guide-for-part-c-state-staff-2/ 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
Phase III: Administrative Activities Policies and Procedures Infrastructure Agreements Applications
Phase 4: Ongoing Monitoring Changing Demographics Changing Political & Economic Context New Interagency Agreements New Funding Sources Revised Policies Increased Support and Guidance
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
FINANCING IS ALL ABOUT BUILDING RELATIONSHIPS
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