Journal of Early Intervention

http://jei.sagepub.com

Service Coordination Models: Implications for Effective State Part C Early

Intervention Systems
Y. Gomm
Journal of Early Intervention 2006; 28; 172
DOI: 10.1177/105381510602800304

The online version of this article can be found at:

http://jei.sagepub.com

Published by:

http://www.sagepublications.com

On behalf of:

Division for Early Childhood of the Council for Exceptional Children

Additional services and information for Journal of Early Intervention can be found at:

Email Alerts: http://jei.sagepub.com/cgi/alerts

Subscriptions: http://jei.sagepub.com/subscriptions

Reprints: http://www.sagepub.com/journalsReprints.nav

Permissions: http://www.sagepub.com/journalsPermissions.nav

Citations http://jei.sagepub.com/cgi/content/refs/28/3/172

Downloaded from http://jei.sagepub.com by sorina constandache on April 23, 2009

Service Coordination Models: Implications for
Effective State Part C Early Intervention Systems
Y GOMM
AND
New Mexico Department of Health
Twenty years ago, amendments to the
Education for All Handicapped Children
Act (P.L. 99-457, 1986) included language
that required each state early intervention
system to ensure that families had access to
a case manager (service coordinator). Like
many of the requirements, however, states
and territories were able to develop their own
approach to implementing a statewide system
of service coordination. The article by Carl
Dunst and Mary Beth Bruder and the study
conducted as part of the Research and
Training Center (RTC) on Service Coordi-
nation provide valuable insight into the
effectiveness of various models for imple-
menting service coordination. As states
evaluate their effectiveness in promoting
child and family outcomes, this article will
be useful in conducting system evaluation
and improvement.
As the Dunst and Bruder article points out,
states have established a variety of different
models for implementing service coordination.
During the 5-year planning phase for imple-
mentation of Part H of P.L. 99-457 (now Part
C of the Individuals with Disabilities Educa-
tion Act, 2004), states often adopted or added
onto existing case management systems, rath-
er than designing service coordination systems
from the ground up. For example, a state
whose chosen lead agency for early interven-
tion was the mental retardation/developmen-
tal disabilities agency might have used the
private and independent contracted case
management provider system already estab-
lished. Another state might have utilized case
managers who were state employees within the
172
Downloaded from http://jei.sagepub.com by sorina constandache on April 23, 2009
Maternal and Child Health (MCH) program
within their Department of Health lead
agency. Currently, the majority of state Part
C early intervention systems are within state
health agencies, the next largest being state
education agencies, and the others being
within social/human services or rehabilita-
tion/developmental disability lead agencies.
Several states have joint lead agencies. Some
states have changed lead agencies over the
years, leading to changes in their service
coordination model. Other states have un-
dertaken significant system change that has
led to changes in the service coordination
model, while the lead agency has remained the
same. This article can be used by states as they
make decisions about which model or models
of service coordination to utilize when facing
a change in lead agency, during system
redesign, or as part of an ongoing review of
effectiveness of their state early intervention
system.
The choice of lead agency is likely to have
a significant influence on the model of service
coordination adopted by a state where strong
institutionalized attitudes regarding service
coordination and case management exist.
For example, the agency might consider that
independent service coordinators are more
able to advocate effectively for the needs of
families or that state employees are more
likely to ensure that private early interven-
tion providers are held accountable to pro-
vide all supports and services in accordance
with the family’s individualized family service
plan (IFSP). The Dunst and Bruder article
can be used to challenge some of the of these
perceptions and to answer questions that
state administrators, state interagency co-
ordinating councils (ICCs), and other stake-
holders might have about the effectiveness of
their current service coordination system. In
light of the findings of this study, it is
advisable for all states to examine their
current service coordination model.
In addition to lead agency designation,
other factors that might influence the model
or structure for service coordination in a state
include (a) the structure of the Part C early
intervention system (e.g., centralized or de-
centralized) ; (b) the funding mechanisms for
service coordination and requirements of
these funding sources; and (c) the over-
arching political climate.
Many of the study’s findings point to the
effectiveness of the blended model of service
coordination, where the service coordinator
also provides one or more other early
intervention services under Part C of the
IDEA. The blended role of service coordina-
tion is similar to the primary service provider
approach for the delivery of early interven-
tion supports and services within everyday
routines, activities, and places. The primary
service provider model promotes a relation-
ship-based approach, founded on the idea
that early intervention is more effective if the
family can develop a relationship with one
lead early interventionist, who is given
support from others on the team. The Dunst
and Bruder article similarly suggests that
parents see the blended service coordination
model, which involves one less person with
whom they have to communicate and de-
velop a relationship, as the most effective
way to meet their family’s needs.
While this study clearly identifies the
blended service coordination model as most
likely to promote quality service coordina-
tion practices, there might be a risk of
demonizing the dedicated and independent
service coordination models. The article
suggests that the challenges for dedicated
and independent service coordination models
are that they involve less interaction time
with the family and challenges in coordinat-
ing supports and services across multiple
Downloaded from http://jei.sagepub.com by sorina constandache on April 23, 2009
systems. Through effective training and
support, it is possible that these barriers
could be overcome. The article also refers to
the effect of high caseload size for dedicated
models. High caseload size not only effects
dedicated service coordination models but all
models of service coordination. Service co-
ordinators who provide other early interven-
tion services to families and children also are
likely to struggle to provide effective prac-
tices when their caseloads are high. With
a high number of families on their caseloads,
service coordination functions might be
overlooked in the effort to provide direct
early intervention services. The federal ap-
propriation for Part C of IDEA has been
reduced in the last several years despite
a continued increase in the number of eligible
infants, toddlers, and families served. States
and communities are struggling to absorb
these additional costs, and increasing case-
load size has been a reality in many Part C
early intervention systems.
The Dunst and Bruder article fails to
identify advantages that might be associated
with the dedicated and independent models
of service coordination. These might include
the ability to specialize in serving particular
population groups such as (a) families with
children who are medically fragile or who
have special health care needs; (b) families
with children with a particular condition (e.g.
Autism Spectrum Disorders, sensory impair-
ments) ; and (c) families with complex social
and environmental situations (e.g. abuse or
neglect, substance abuse, psychological dis-
orders, domestic violence, homelessness).
The dedicated and independent models could
allow service coordinators to build the
knowledge and skills to coordinate supports
and services effectively to meet the needs of
these families.
Other articles by the authors (Bruder,
2005; Bruder et al., 2005; Dunst & Bruder,
2002) focus more specifically on the key
effective service coordination practices that
were identified through the Research and
Training Center study. These key practices
have implications for states as they design
training and technical assistance for service
173
coordinators. States also might want to
develop competencies that supervisors can
use to promote effective service coordination
practices through reflective supervision.
Ultimately, the more significant challenge
for states might be how to promote these
effective practices for service coordinators to
meet the needs of infants, toddlers, and their
families, rather than which model or models
of service coordination to utilize.
REFERENCES
Bruder, M. B. (2005). Service coordination and
integration in a developmental systems ap-
proach toearly intervention. In M. J. Gur-
alnick (Ed.), The developmental system ap-
proach to early intervention (pp. 29-58).
Baltimore: Brookes.
174
Downloaded from http://jei.sagepub.com by sorina constandache on April 23, 2009
Bruder, M. B., Harbin, G. L., Whitbread, K.,
Conn-Powers, M., Roberts, R., van Buren,
M., Dunst, C., Mazzarella, C., & Gabbard, G.
(2005). Outcomes of service coordination: An
evidence based model for research and prac-
tices. Topics in Early Childhood Special
Education, 25(3), 177-188.
Dunst, C. J., & Bruder, M. B. (2002). Valued
outcomes of service coordination, early in-
tervention, and natural environments. Excep-
tional Children, 68, 361-375.
Individuals with Disabilities Education Improve-
ment Act, Amendments of 2004, Pub. L.
No. 108-446, U.S.C. 20, § 1400 et seq.
Correspondence concerning this article should be
addressedto Andy Gomm, Family Infant Toddler
Program, New Mexico Department of Health,
1190 St Francis Drive, Santa Fe, NM 87502-6119.
E-mail: andrew.gomm@state.nm.us