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Formulating optimal state early childhood intervention policies.

Formulating Optimal State Early Childhood Intervention Policies

The past decade has witnessed an increased federal involvement in the educational, psychological, and social-familial needs of young handicapped children. In 1975 the preschool State Implementation Grant and Preschool Incentive Grant programs of Public Law 94-142 were enacted. These federal programs encouraged state and local governments to increase and enhance their services to young handicapped children.

Two major amendments to P.L. 94-142 further accelerated this policy-making process. P.L. 98-199, the Education of the Handicapped Amendments of 1983, established a state-level process designed to encourage planning and coordination of all early education programs with particular emphasis on handicapped infants and children. The amendments established and funded multiyear state-level efforts, known as State Plan Grants, that were designed to provide expanded services to more children starting at earlier ages, with increased state agency intercoordination.

These amendments have since been superceded by a new amendment, known as P.L. 99-457, signed into law in 1986. This law represents the most far-reaching federal policy ever implemented for early childhood intervention. Although the bill stops short of mandating universal services to children younger than age 5, it strengthens incentives for states to serve 3-6-year-olds, and it establishes a new discretionary program for services to birth-3-year-olds. In short, it will result in nearly all states significantly increasing their programs for young handicapped children and modifying and expanding their policies. The direction these changes take will be dictated, in part, by the regulations formulated for P.L. 99-457. However, future early intervention efforts will also be influenced by existing state policies, as well as by each state's perception of the composition of optimal state early childhood intervention policies.

This study is designed to assist this policy-making process by answering two important research questions. First, what is the status of state early childhood intervention policies nationwide prior to the implementation of P.L. 99-457? In particular, what are the states' existing policies regarding children to be served, lead administering agencies, services to be provided, funding sources, interagency contracts, program regulations, certification of teachers, and training of professionals?

The second research question focuses on how the states' policies compare with an index of optimal early childhood intervention policies. By comparing existing policies to such an index it is possible to determine which areas of state policy making represent strengths and weaknesses, whether a mandate or an entitlement are sufficient conditions for establishing optimal policies, and which factors contribute to optimal early childhood intervention policy.

METHOD

Study Design and Respondents

A questionnaire consisting of 26 closed-ended, or forced-choice, questions that focused solely on current state policies was distributed to the directors of the P.L. 98-199 State Plan Grants in all 50 states and the District of Columbia. The questionnaires were returned by all of the states and the District of Columbia between December 1985 and May 1986. Forty-five of the respondents were Coordinators or Directors of their state's planning grant; the other respondents held Early Childhood Special Education supervisory positions in their State Education Agency (SEA). For convenience, states will refer to all respondents, including the District of Columbia.

Reliability

The majority of the data reported in this study consists of the perceptions and information available solely to the State Plan Grant directors. Nevertheless, it was possible to compare approximately 25% of the questionnaire items with information available from three other sources: a Congressional Research Service monograph on early intervention (Fraas, 1986); a national directory of state early childhood special education services (Carran, 1984); and a series of documents about individual state laws and policies collected by the State Technical Assistance Resource Team (START), an organization funded by the U.S. Department of Education to provide technical assistance to state planning grants. Discrepancies between any of these sources and the questionnaire responses were resolved through telephone discussion with the original respondent. The internal consistency of the questionnaire as a whole was measured by a Cronbach alpha as .56.

RESULTS

Results are presented in two major sections, corresponding to the two central research questions. The first section focuses on the present status of state policies. The second major section reports on the application of these data to an index for rating optimal state policies and resources.

Current Status of Early Intervention Policies

States With Mandates and Entitlements. P.L. 94-142 established an entitlement for services to handicapped children beginning at school age; services prior to school age were subject to individual state statutes and mandates. An entitlement recognizes the right of every child to avail himself or herself of a service, while a mandate requires only that a service be provided. P.L. 98-199 left the entitlement structure of P.L. 94-142 in place, although it provided planning funds for early childhood intervention services beginning at birth. In 1985-86, when this survey was completed, only 6 states had entitlements that guaranteed services to all children with any handicapping condition from birth onwards. An additional state had a mandate to serve birth-3-year-olds. In addition to these states, one state's entitlement began at age 2, and 7 other states mandated birth-3 services for children with specific handicapping conditions. Sixteen states had entitlements beginning at age 3, 4 states began at age 4, and 17 states began at age 5. Eight states (16%) had no entitlement for services below age 6. It is of interest that only 3 states indicated that they provided mandated services for environmentally at-risk birth-3-year-olds; 5 states mandated such services for 3-6-year-old at-risk children.

Lead Administering Agency. Birth-6 services were administered in an exceptionally wide variety of ways. Some states with entitlements had only one or two state-level lead administering agencies, that is, agencies with overall responsibility for the delivery and coordination of services. Many other states had no single agency or pair of agencies with primary responsibility for managing intervention services, but relied instead on a loosely defined confederation of state agencies or even on local agencies. In some states early intervention services were managed by as many as seven different types of agencies, all operating semi-autonomously. On the average, every state listed three to four agencies with primary responsibility for managing birth-6 services.

For birth-3 services, the most frequently named lead administering state agency was Public Health (N = 28; 54.9%), followed by the SEA, and by the state Human or Social Service Agency (N = 23 for each agency; 45.1%) and such private agencies as Easter Seals, United Cerebal Palsy, Catholic Charities, and Association for Retarded Citizens (ARCs), (N = 18; 35.3%).

A very different pattern of lead administration was revealed for 3-6-year-olds. The most frequent lead agency was the SEA (N = 37; 72.6%), followed by the Local Education Agency (LEA) (N = 29; 56.7%); and by Public Health (N = 18; 35.3%). Only 25.5% of the states (N = 13) reported major administrative involvement of private agencies with 3-6-year-olds. Thus, services for this age group reflected a combination of state and local authority, as contrasted to birth-3 services, which lacked local agency involvement.

Funding Sources. Funding patterns for early intervention services were nearly as diverse as the administrative arrangements designed to manage those services. Although the actual, proportional contribution of each funding source was not included on the survey, more than a dozen funding sources were identified by the respondents, including P.L. 94-142, state or local taxes, Medicaid, Chapter 1, P.L. 89-313 (although a subprogram of Chapter 1, it was listed separately on the questionnaire because of its long history of being an independent funding source), P.L. 98-199, and other sources noted by the states--e.g., private insurance, parent fees, private third party payments, Maternal and Child Health, Developmental Disabilities, Supplementary Security Income, and Head Start.

When policies were analyzed across birth-6 services, all states (with the exception of 1) reported using P.L. 94-142 funds. Forty-six states (90.2%) noted that state and local funds were also used, while 34 states (66.7%) indicated that Medicaid funds were also used to support these services. However, differing funding patterns emerged when responses were divided by age. The first three sources for all states serving birth-3-year-olds were state and local taxes (N = 36; 70.1%), Medicaid (N = 33; 64.7%), and P.L. 89-313 (N = 30; 58.8%). When only states with birth-3 entitlements were analyzed, a different pattern appeared: P.L. 94-142 and P.L. 89-313 were both used most frequently, followed by Medicaid and P.L. 98-199 funds.

For 3-6-year-olds the funding pattern was as follows: P.L. 94-142 (N = 50, 98%); state and local taxes (N = 45; 88.2%); and P.L. 89-313 (N = 37; 72.5%). In short, states funded birth-3 and 3-6 services differently. Birth-3 services, except in states with entitlements beginning at birth, were heavily supported by state and local taxes and by Medicaid funds. In contrast, 3-6 services were supported principally by a combination of P.L. 94-142 funds and state and local taxes.

Types of Mandated Services. Which intervention services were mandated in each state, and how these mandates differed for the two age groups was also studied. The results showed similar patterns for both age groups, although there were substantially fewer mandated services for birth-3-year-olds. The most commonly mandated services were Public Awareness and Diagnosis/Assessment. The two least frequently mandated services were Parent Training and Case Management. It is striking that intervention programs were mandated less frequently than diagnostic services, since intervention is a critical component of any comprehensive diagnostic assessment.

Coordination of Services. States were asked to identify the intervention components in greatest need of coordination. Responses indicated that all components were in need of extensive coordination. Those elements in greatest need, birth-6, were Case Management (N = 40; 78.4%), Staff Training (N = 36; 70.6%), and Diagnosis/Assessment and Intervention Programs (both N = 34; 66.7%). This order was retained when the data were analyzed by age group, although every component of the birth-3 services was in greater need of coordination when compared to 3-6 services. In states with entitlements these problems were reduced somewhat, but were still significant.

Obstacles to Coordination. Given that coordination problems were identified in the delivery of early childhood intervention services, the states were asked to identify which problems or obstacles were responsible for the lack of coordination. Table 1 lists the problems that were included in the survey, and it shows the responses by age group and by entitlement versus no entitlement. These results clearly show that states with entitlements reported fewer obstacles than did states without entitlements. Nevertheless, the list of problems is lengthy and indicates that entitlements alone do not alleviate the obstacles to coordinated services.

State Regulations and Guidelines. Several items on the survey focused on formal Early Childhood Special Education guidelines, regulations, or standards. Although the survey did not control for variations in how extensive and complete these regulations were, 22 states (44.3%) reported that they had some formal guidelines for birth-3 services, and nearly three-fourths (N = 37; 71.2%) of the states answered affirmatively for programs for older children. Nearly half the states (N = 23; 44.2%) reported that they had undergone changes in laws or regulations concerning birth-6 programs since 1982. Of those states without birth-3 guidelines, 54.5% planned to enact them by 1988; 71.2% of the states without 3-6 guidelines indicated their intention to do so in that time period.

Certification and Supply and Demand. One-quarter of the states reported that no certification was required to teach handicapped children, birth-6. The absence of stringent certification standards may reflect the alarmingly low numbers of trained personnel. Table 2 contains data regarding supply and demand of professionals. Severe shortages of special educators and therapists (i.e., occupational therapy, physical therapy, and speech) were reported by nearly every state. Moreover, these shortages were expected to persist into the foreseeable future (1988-89).

A majority (68.6%) also reported that they lacked sufficient training programs to prepare needed professionals. The shortage of training programs was attributed to the following: Limited funding to start new training programs (78.6%); insufficient interest within training institutions (47.6%); not enough interested students (26.2%); too few job opportunities (26.2%); and difficulty in satisfying state certification requirements (9.6%). In brief, the data concerning supply and demand and availability of training programs points to dramatic problems that will beset this area for years to come.

An Index of Optimal State Policies

The states' responses to the questionnaire provided comprehensive information about their early childhood intervention policies prior to the implementation of P.L. 99-457. Whereas all this information is potentially of use to state policy makers, these descriptive data only indicate how optimal an individual state's policies are in absolute terms. They do not enable a state to evaluate its own policies relative to other states' policies. Thus, an index was constructed that would permit the data from seven areas of the state questionnaires to be aggregated and compared.

In formulating the index it was not assumed that all aspects of a state's early intervention policies were equally important. Hence, a weighted index was devised with entitlement for all handicapping conditions, birth-6, receiving the highest a priori weighting, followed by criteria concerning intervention services mandated, number and source of funding sources, number of interagency contracts, type of overseeing agencies, formal guidelines and regulations, and types of professional certification. Table 3 lists the sources of data for the index and supplies further information about its a priori weighting. Since the index was based on a ratio scale, states that only partially fulfilled the criterion listed in Table 3 for a particular subscale were given partial credit, according to a formula derived from the specific questions included in the survey. Thus, entitlement for all handicapping conditions, birth-6, would receive 30 points; entitlement only for 3-6 would receive 15 points. The sum of the scores from each subscale comprised each state's total index score (maximum = 100 points).

The index corresponds to previous research about early childhood intervention policy (see Allen, 1984; Behr & Gallagher, 1981; Meisels, 1985). Moreover, the seven areas or subscales included in the index were closely linked to the broad criteria for early intervention services outlined in the Report of the House Subcommittee on Select Education (Report 99-860) that accompanied P.L. 99-457 (U. S. House of Representatives, 1986). That report identified the following essential criteria: Overseeing agencies; funding; handicapping conditions served; state regulations or standards; intervention services; professional certification; and individualized family service plans. Data concerning all of these aspects of early childhood intervention were included in the index with the exception of family service plans. In addition, data concerning interagency contracts--an element of intervention implied by the above criteria--was factored into the index.

Pearson product correlations between the index subscales and the total index score showed highly significant (p [is less than] .001) correlations between the total index score and three subscales: handicapping conditions served (r = .84), services mandated (r = .84), and regulations (r = .56). There were also strong relationships between handicapping conditions served and mandated services (r = .71, p [is less than] .001), and between handicapping conditions served and established regulations and guidelines (r = .43, p [is less than] .01).

To better understand the correlational relationships an analysis of the mean scores of each subscale was undertaken, with these scores divided into four groups based on quartiles of the total index score. Significant mean differences across the quartiles were observed for the same three variables: handicapping conditions served, or entitlements (F(3, 47) = 26.4, p [is less than] .0001), services mandated (F(3,47) = 45.0, p [is less than] .0001), and regulations (F(3,47) = 6.0, p [is less than] .001). None of the other subscales achieved significance across the quartiles. These findings are further displayed in Figure 1. This figure shows the means of the states in the first and fourth quartiles and demonstrates that these three subscales are the most discriminating variables in the policy index.

Figure 1 depicts the standardized means of the states in the most optimal and least optimal quartiles. As noted, it shows significant differences between the means in terms of handicapping conditions served, intervention services provided, and state regulations (post-hoc Bonferroni contrasts are p [is less than] .0001 for the first two variables, and p [is less than] .005 for the third). However, the figure shows no reliable mean differences on the other subscales: overseeing agencies, funding sources, formal interagency contracts, and certification. In other words, even in states with regulated policies supportive of many services for most children, the pattern of scores on the index indicates that problems may remain in other critical areas--specifically funding, interagency cooperation, and lead administering agencies. It is precisely these areas that have been shown to have a major impact on service delivery (see Meisels, 1985).

DISCUSSION

This study carefully reviewed the early childhood intervention policies of all 50 states and the District of Columbia. It concluded that extensive variation exists among the states with respect to these policies. Since the passage of P.L. 94-142, very few states have undertaken the task of establishing uniformly optimal policies. The variability identified by this study exists in every aspect of early childhood intervention policy, although it is most pronounced when states with or without entitlements are compared, and when policies for birth-3-year-olds are contrasted with those for 3-6-years-olds. Services for birth-3-year-olds in states without entitlements are governed by the least optimal policies of all.

This study focused solely on state policy. No conclusions can be drawn from these data about the relationship between policy formation and policy implementation, or service delivery. This is seen most clearly by further analysis of the data from the weighted policy index. For example, entitlements are strongly reflected in the discrimination between most and least optimal states. All six of the states with birth-6 entitlements were found in the first quartile displayed in Figure 1, and six of the eight states with no entitlements below age 6 were in the fourth quartile. Whiel this suggests uniform policy, six states without entitlements were in the first quartile, and two of the permissive states were in the middle two quartiles. Indeed, at least two states that were included in the fourth quartile may be among the leading states in the nation in terms of services provided to young handicapped children. Similarly, several states in the first quartile have not begun to implement the programs that are implied by their policies.

In other words, early childhood intervention programs are heavily influenced by entitlements, but other issues are reflected in the establishment of overall optimal policies as well. Specifically, even in states with entitlements, policies regarding funding, lead agency administration, and formal interagency cooperation are much less than optimal. Where there is confusion about these issues, it is likely that services will be less than ideal.

What can be done to make state-level policies more uniformly optimal? A beginning response to this question emerges from the new federal initiative. With the passage of P.L. 99-457, the Education of the Handicapped Amendments of 1986, a bill has been signed into law that encourages mandated services be provided to the maximum number of children in an interagency-administered environment with substantial federal funding and well-planned regulations and guidelines. The bill also supports the development of training programs to prepare much-needed professionals. Most of the funding in the bill, however, is reserved for programs for 3-6-year-olds; birth-3-year-olds are still treated differently and, from a policy vantage point, less optimally than the 3-6-year-old children. Moreover, there is a potential shift in lead administering agency and children served between birth-3 and 3-6.

Thus, two critical tasks face state policymakers today, lest optimal policies remain divorced from optimal services. The first task is to implement fully the provisions of P.L. 99-457 that are designed to create truly optimal programs for handicapped 3-6-year-olds while simultaneously drawing attention to the need for establishing high-quality programs for birth-3-year-olds. The second task is to focus attention on the policy infrastructure of early intervention, that is, the policy areas that are managed at a state or local level, and that are largely responsible for assuring the quality of the programs that are mandated and entitled. Funding, program administration, interagency coordination, and professional training comprise this infrastructure. To the extent that these areas are strengthened and emphasized, the correspondence between policy and practice will increase, and services to young handicapped children will be improved.

REFERENCES

Allen K. E. (1984). Federal legislation and young handicapped children. Topics in Early Childhood Special Education, 4, 1-8.

Behr, S., & Gallagher, J. J. (1981). Alternative administrative strategies for young handicapped children: A policy analysis. Journal of the Division for Early Childhood, 2, 113-122.

Carran, N. (1984). Results of a survey by the National Consortium of State Education Agency Early Childhood/Special Education Coordinators. Des Moines, IA: Department of Public Instruction.

Fraas, C. J. (1986). Preschool programs for the education of handicapped children: Background issues, and federal policy options. Washington, DC: Congressional Research Service, Publication HV750A.

Meisels, S. J. (1985). A functional analysis of the evolution of public policy for handicapped young children. Educational Evaluation and Policy Analysis, 7, 115-126.

U.S. House of Representatives (1986). Education of the Handicapped Act Amendments of 1986. (Report 99-860). Washington, DC: U.S. Government Printing Office.

SAMUEL J. MEISELS is Professor, School of Education and Research Scientist, Center for Human Growth and Development, University of Michigan, Ann Arbor. GLORIA HARBIN is Associate Director, Carolina Policy Studies Program, University of North Carolina, Chapel Hill. KATHY MODIGLIANI and Kerry OLSON are Research Associate, University of Michigan, Ann Arbor.
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Author:Meisels, Samuel J.; Harbin, Gloria; Modigliani, Kathy; Olson, Kerry
Publication:Exceptional Children
Date:Oct 1, 1988
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