TSBVI Coffee Hour: ECI Nuts and Bolts
4/5/2021

>> Hello, welcome, everybody. We will wait just a couple of minutes before we get he started. While you are waiting, so feel free to set your that do all panelists and attendees so that everyone can see your questions and comments in the chat. As always we always love to see where you are from if you want to put that in the chat while we are waiting and get started in just one minute. Mansfield, Waco. Knoxville, Tennessee. Houston. Vegas. El Paso. Carrollton. Keller. Fort Worth. Seguin. Tennessee. More Vegas. Magnolia, Texas. The. 

>> Welcome, everybody, we will go ahead and get started, we are so glad you are here with us. You should, if you have a question or comment during the time the present search speaking please post that this the chat box and make sure it says all panelists and attendees so that everyone can see. Your microphone and cameras are automatically muted so you don't need worry about that. The handout for today's session is shared in the chat for immediate viewing and we will also be available for later viewing, along with a reporting of this and past coffee hour sessions, shared in our coffee hour page,. The -- TSBVI.edu/coffee hour, once you are on the page scroll down to under the list of sessions where it says the, look at the new TSBVI happy hour archive that is a link that will take you to the recordings, transcripts and chat information. CEUs when you respond to evaluation it will e-mailed to you from our website -- works, you will get that this evening. You will give the code at the end of today's session and the CEU certificate will automatically generate upon the completion of that evaluation. There is only opening code, adjust closing code and given at the end of today's presentation. We will 0 start the, stop presentation at 355 and give you the code and announcements. Happy to. 

>> #01: Today's presenter to you. Jackie Gregory. 

>> Thank you, Kaycee, hello, everyone. Good to be with you today. I am going to go ahead and get my screen shared here. And we can get started. All right. So today, I am going to be going ECI nuts and bolts so very generally talking about ECI and the way that we all collaborate and work together. I will be talking about Texas ECI today. And again as Kaycee mentioned my name is Jackie Gregory the child outreach coordination for any babe by can, early intervention program that is here in Austin, Texas so we will just be kind of getting into this and talking a little bit about our collaborations. If you have any questions, normally I am used to doing these things in you know, in a room with all of your beautiful aces and I really like that dialogue, so we can just go ahead and jump in with questions. If for some reason maybe I want to get some clarification on a question or review a rule, I can go ahead and take down the questions and send out a follow-up e-mail after the presentation. Okay? All right. And a lot of you are likely already working with ECI, right? You kind of know the gist of this, some of this information is going to be a review for you, but bear with me because we are going go kind of through it all a little bit. But we are going to go a little more in-depth about our collaboration with hard of hearing providers and our vision impairment teachers and OLM specialists so se a statewide program within the Texas Health & Human Services commission. You see this adorable little baby which I think important to have in these presentations right because this is who we love and this is why we do what we do. From birth up to age 3 who have a qualifying developmental delay, disability or a medical diagnosis that can have an impact on development, and as mentioned we collaborate with our local education agencies in order to assist these little ones to get the services that they need for their hearing loss or their vision loss. I am a very visual person and so I really like this little flowchart that is on this next slide, so ECI is authorized through individuals with disabilities education act a or idea, part C program. So the part C program recognizes the need for .. identifying little ones in need or of services from birth to age 3, Part B of idea works with little ones that are transitioning out from 3 to age 21 so we will talk a little bit about that transition later on in the presentation as well. So we are going to kind of go step-by-step here. Texas Health & Human Services commission is our state reporting agency, our state governing agency in the state of Texas, so all of the programs in the state of Texas report directly to HHSC. We report to them when we are completing our evaluations, where we are -- when we get referrals, we are reporting our services so everything that is happening with our little ones we are reporting directly to HHSC, and those are being monitored really just to make sure that we are all doing our jobs to make sure we are all identifying little ones in need of services and that we are providing those services in a timely manner. ECIs are designated by service areas, right. 

>> So for example, my ECI program any baby can we worked in Hayes Blanco Llano and Travis County and border with another ECI program called Easter seals, and another called bluebonnet trails, ECI pride, and so, we are housed, ECI programs are housed in post agencies, there is a contractor of the state, we are legally bound by federal and state rules, which is why it is always important for us to work hard together, because I know that sometimes we have different sets of rules with the LEA and we have our rules and combining our powers to make sure we are serving these little ones and following those rules together. So as you can see we will the flowchart we follow rules from the feds, from the state, that trickles down to our state governing agency, HHSC, and then our ECI providers and you all, the LEA providers are on those front lines providing those services to our little ones. So I reference add couple of the rules, our big rules we follow, code of value regulations CFR and tack, the Texas administration code as mentioned we will be talking about Texas ECI today .., these are just a couple of the big rules we are following, but also in different ECI programs they may have to follow other rules related to the county that they live in and there is -- there are other rules a and regulars that, regs that kind of come in play with the agency and things like that .. but across the state of Texas we are all bound by CFI and TAC to make sure we are following through with those rulings and regs. Okay. All right. A talking about rules and regulations, segue into a very busy slide, which I know is not the jam to do during a presentation, radio submitting you just throw a bunch of words on the screen, but this is a rule I feel is very important for everyone to have their eyes on, it is also a part of my rule as the outreach coordinator to make sure that our healthcare professionals that are social services agencies that our community is aware of our services and also what is required of healthcare professionals. So this rule basically states that once identified, a child, once a child is identified with the developmental delay or a developmental need, a healthcare professional should be referring that child to an ECI program. We do not have to be the only choice offered for these families, but it is important that we are one doff options, and really this is to serve as kind of a catch-all net, I like to say, to make sure that we are identifying these little ones, hopefully during these kiddo's well child checkups, their pediatrician is going through a screening, a developmental screening with them and they are able to identify if for some reason a child is maybe falling bin in an area of development, and then this rule will come into place and they would refer them to ECI or another you know, therapy resource, but ECI should be one of those options, and then we will help to make sure that that kid co is getting access to services if needed. So, yes, so a very important rule, also whenever I am doing outreach to our healthcare professionals, this is something that I include in the packets, because I found that there are still a lot of healthcare professionals and providers that aren't aware of this rule, so I just really like to make sure everyone has their eyes on it. A okay. All right. So as you know -- as you may know, a lot of you are already in the field working with our teams and things, ECI is a little different. We are very different in a very unique and beautiful way from maybe a private therapy partner or a provider. In that we have an education coaching model, families play a huge vital role in our services. They are most important team member and we are not just going in working one-on-one with the kid, we are working collaboratively with other members of the team and the family, right? Because we believe that the family, the parent is the child's most important and impactful teacher and we really want to empower them and encourage them and coach them into learning strategies that they can implement on a daily basis, daily basis with their little one. We a focus on family centered services, so if a family is experiencing food insecurity or if a family is having issues with perhaps not being able to pay their electricity bill or they are being evicted, those are some basic needs, right? And it is going to be very difficult for a family to be able to focus on their child's development and their child's therapy needs if they are having a hard time getting food on the table or providing a roof our their child's head and so our services are family centered in that legal end and we go and look at what is going on with the entire family, if they need help in accessing resources to make sure the needs are being met then that is what we are going to do and in turn that will help the family then focus on that child's needs as well and make that a priority as well. Because we know that it is. We know that families are wanting to do all that they can to support their child, but stressors are real, especially during a pandemic, there has been a lot of situations where families have you know, lost employment and so we really focus on making sure that our families are able to meet those basic needs in any way we can, our case managers are really great at helping families learn to navigate those systems. We provide services in the child's natural environment, oh, my gosh, we miss being in the homes, we miss being in the homes, we miss little kids' hugs and working with those families. As most of you know it is a pandemic and we are all in this virtual world. Our programs provide all services by telehealth which has also been a very beautiful thing because it fits perfectly with our coaching model, you know. Although we miss hugs we are still very grateful we have been able to continue to reach our families and provide services virtually and we have some really great stories of families who just feel super empowered and just ready to take it all on, even during this pandemic, so it has been really great, but typically when we are not doing during pandemic times we will go to every the child is during the day so if that child is home, that's where we are going, if they are with their grandparents, if they are in a day-care, wherever that child is, that's where we want to go and provide services, so that we can really see what is happening in that child's daily routine. We are approach -- infinite -- evidence-based practices. So we all know how impactful this zero to three years are in brain development, we know there is rapid growth during these years, I would like -- I like to say it is in the name, early intervention, right? We know that the earlier we can get in there, the better. We can make a huge impact during this time and so I have this one story working with a family and we were asking a hard time getting -- buy in from the dad. He just didn't understand why they were in the home. He didn't think that the baby needed our services and the mom is feeling very concerned and overwhelmed so I said, okay, well let's schedule a time when I can come, when dad is home, so we did, we went, we did a visit after you know, the workday when dad got home and I was sharing information with dad, getting to know him, you know, and talking about brain development and just discussing his concerned and you know, his concerns and feelings and I sweared dad that during the zero to three years 700 to 100,000 neural connections are formed every second and how impactful his role is as a parent and nerve the home every second and his dad just broke down in tears, he just broke down crying and I feel like, it still gives me goose bumps I feel in that moment he really realized his power, he knew he was very special and you know, in his child's life but in that moment he realized all that he could do every second with his child and he was present for every session, we had huge buy-in from him and excited to practice a strategies and the whole family became involved. So in is just kind of what we do, right? What we do in ECI all of us the way we work with families. We collaborate as a team which is really awesome especially was a, because we need you all, we need our ECI, and I say you all, the I am talking to everybody, but I am talking about how we collaborate with our DH and teachers because RDH and -- teachers are the expert in that field and it is important that we all work as a team, with the family and with our different you know, experts to make sure that we are looking at that and doing our best to serve them. 

>> All right. So I am going to talk a little bit about the steps in ECI. The first step is obviously always referral. We have received referrals from everybody, anybody can make a referral to the ECI program. But as you know, as mention Jed a lot of partnerships with our local healthcare professionals and our clinics so we receive a lot of referrals from them. CPS, social service agencies a lot of the community partners so a referral can come from anywhere, a family, a friend, after we receive a referral, we will contact that family, we will tell them all about our program, all of the wonderful things we have to offer and if that family is interested in moving forward then we will schedule a comprehensive assessment. And we call it a comprehensive assessment because as mentioned before, we are looking at everything, right? We are looking at all areas of that child's development, we are also looking at kind of what is going on in that family unit. Okay. So let's talk about eligibility criteria. Just moving my camera over, and my screen over here, so I can see my slide. There we go. So these are the three ways that a kiddo can be eligible for ECI services, these are the ways that we are able to kind of document their eligibility. So under qualifying medical diagnosis, ECI compiled a long list of qualifying medical diagnoses and these have all been shown to have an impact on development, or these little ones may be at risk for having a developmental delay or a need as they get older throughout their life. Examples of this could be cerebral palsy, autism, Down syndrome, and so if a little one is qualifying under medical diagnosis we still will need to show a need for services, right? And that could be also a case management need in helping that family get access to services that they need. Or to seeing a specialist or to things like that. Another way if a child is deaf or hard of hearing or has a visual impairment. And that eligibility must include the documentation that we need from specialists, so we will talk a little bit more about that documentation here in some other slides as we keep moving on through this presentation, but it is important to note that DHH eligibility does not require a language delay. And then the third way is under developmental delay. So determine eligibility under developmental delay, ECI programs in the state of Texas administer an a approved standardized evaluation tool, so these tools cover all areas of development, again, we are looking at that whole child, even if a family contacts us and submits a referral for communication concern or a gross motor concern we are going to be looking at all areas of development, so in order for a child to qualify under developmental delay, they must show a 25 percent delay in one or more areas, if the child is only showing a delay in expressive communication, they must show a 33 percent delay. And these are rules that we are following. This is all across the state of Texas, this is how little ones are deemed eligible for ECI services. And I added this note down here about Texas Education Agency, as I thought that would be an important thing for us in this presentation, so I am just going to read it, and Texas children with an -- are entitled to a free appropriate public education from birth, therefore, services for a child with an AI or VI from birth to 36 months must be coordinated between local ECI program and the LEA for the area where the child resides. I would like to explain to families to try to help them understand how it is that we collaborate and we work together. I like to use the word gatekeepers, so I tell the families, you know, we are essentially the gatekeepers in order for your little 2015 receive services from the local school district. So that way it is easy to kind of communicate the importance of how we must work together for their little 2015 get access to these services. Okay. So after we receive the referral, a child has their assessment, their developmental comprehensive assessment completed, they are deemed eligible for ECI services or they are not deemed eligible for ECI services. If they are not deemed eligible then we are going help that family to walk away with some helpful resources, if they still need some support. If they are, we are going ask the family if they are interested in enrolling in our program. We are a voluntary program and we want to make sure that families fully understand our service delivery and how we function as an ECI program. So the family says, yes then we follow through with completing an individualized family service plan meeting. We are also known as IFF -- IFSP, we live in a world of acronyms, the world of alphabet soup so we always have all of these different, you know, these different letters that we throw around, but I am sure you all are very familiar with an IFSP or ECI and you know, when you are working with the school. So one of these timeline requirements is that the IFSP must be written within 45 days of the referral to TCI so from referral to IFSP, 45 days, that seeps like a really long time, right? If we have a kiddo who is in need of services, we are really starting to get those kiddos evaluated and enrolled quicker, right? I mean, that is a good timeline and sometimes families need to plan or we are working to get the necessary medical documentation to enroll that child under DHHS or ECI availability, maybe they have an appointment with a specialist coming up but we are really starting to get that kiddo enrolled because early intervention, right? We want to do it as fast as we possibly can. 

>> Jackie, I just want to mention that you have had some comments come in. Just really appreciating the team approach to TCI and a question came in asking about the eligibility requirements you mentioned the -- event and if they vary from state by state or if they are national. 

>> That is good question I should probably know the answer to, let me get a clarification on that, okay? And I will let you know, in Texas that's what we are doing,. 

>> Yes. So let me get confirmation of that. Great question. 

>> I believe so. But let me just look at the rule and I will share that with you. Yes. Team approach is everything. Team approach is so important for these little ones because we are really able to kind of just take from all of the experts and then we have a dream team. So okay, so we are going to do a little bit more about accessing DHH services and then we will switch to accessing the I services. And again this is just kind of a general review of how that happens. Of course, the most important thing is consent, right? We need consent. We always need consent so that we can coordinate and collaborate and just make sure that we are able to share information for that little one. So we get consent, if we get a referral for a little one, or the audiological, otological evaluation for a little one the family wants access to DHH services we will contact that family and get consent to communicate with the LEA as soon as possible. We want to loop in the LEA as soon as possible so we are able to just get ball rolling for that little one. We are the incally always getting the Part B, call it a Part B, it is the otological examination, we are always getting that one first, so that will come in and contact family gets consent, see where the family is at in their journey, right? If the family has already been able to get scheduled request the ENT, if they already have the documentation that is necessary for us to proceed to the next step, we are just going to touch base with that family, our case manager is going to talk to them and guide them based on wherever they are at in their journey for going out that kiddos' hearings needs or hearing loss. We will also need the otological examination that will typically come from an ENT, now if for some reason there is not one available or we are having a really hard time getting that document, we can contact the kiddos 'can CPC and get a temporary, Part A, we call that document Part A .. and go ahead and get the ball rolling for that little one. The DHH teacher el education a, teacher evaluation is the next part of that but the DHH teacher is involved every step of the way. We need the teacher, sometimes we need help to communicate with the specialist. We need another person requesting those records. We need to make sure that the family is understanding what is going happen next for the little one. This may be a family who has never had a little one with hearing loss and this is all a very brand-new experience for them and we want to make sure that they are supported in that, and our DHH teachers do a really great job of offering that support. So after we have all of this documentation, after we kind of worked with the family, help them kind of get to the specialists that they need, we will go ahead and do an IFSP meeting, if that child is eligible for services we will talk about, talk about that service plan. A big part of what we are doing is first working on goals. We want to ask the family what they want to see their little one doing, what they want for their little one. So we are establishing goals and then talking about the services that are appropriate for that little one and again talking about the team approach, the family is a big part of this discussion, and so we always have to be careful when working with families because we have all been doing this, well some of this have been doing this for a really long time, right? And maybe you can kind of used of going through it and you kind of have in mind what you know what you think, what you feel like this child should be working on, this goal or you want to see them this many times a month. But we really need to take care and take a step back and ask the family these questions as well and make sure we are listening to what the family is wanting and needing, because it can be a lot. So in the handout that I know Kaycee has been talking about and posting in the chat, the handout is just kind of like a really helpful cheat sheet that talks about this documentation documentation and how we work together to get access to it, and a little bit more about the timelines and things like that, okay? So another important thing to mention is that ECI is required to give our LEA partners a 10 day IFSP notification, so this way you have time to plan, right? Because you want to review those documents, you want to you know, kind of know what you are going into and you want to be prepared for that meeting. So it is something to keep in mind. All right. Then accesses the eye service it is. Again step one is concept, we need that consent and want that consent as soon as possible, we want to loop in our. The VIs as soon as possible so we can get that ball rolling for this little one. We are wanting to get our hands on that Texas eye examination report. And if for some reason we receive some documentation that notes that there are vision concerns for that kiddo but that kiddo hasn't maybe been droved a specialist or they were and we don't have the necessary documentation with all of the components, that is something again that our case managers and our -- they are going to be working on to help the family get access to that. So -- but we do need that Texas eye examination report, you need to see that. Also with consent we are talking to the families about the HHS blind children's vocational discovery and development program, we are providing them with information and with consent. We are also referring the families over to that program and just doing a lot of connecting, you know, connecting to resources here. Then we are going to have the INOM teacher evaluation, it is really important that we connect with those experts, right, that we have both the VI and O and M to come in and do that evaluation to help work with the family and determine if that child .. qualifies for those services. And then we are going to add that to the IFSP, we will have an IFSP plan meeting with the teachers involved and we will be adding those services. Now, it is important to note which I was having a conversation with one of my Austin colleagues and we talked about she mentioned the importance to mention this is that the services for DDH and VI must be provided by a certified teacher, so that was a surprise do me because I didn't know that there were any questions about that, but apparently that is a question that circulates sometimes so we need to make sure that we have a certified TDI specialist and provided DDH teacher. It sounds like that makes sense to us, though, right? 

>> All right. So transitioning to talking about goals, ECI goals. I think this is a fun part too when we are talking with families about you know, what they want to see their kiddo doing and so one of the big things we do is help the family to kind of identify a wish, a wish for their child, and then we help that family turn that into a goal, a smart goal, and in ECI we write smart goals and that's a part of this kiddos' chart, so they are specific, measurable, achievable, they are realistic, and we also include routine space because that is a requirement in Texas under agency we are also needing to include a routine so during mealtime you know, when that complied is walk to -- walking to the mailbox or doing their play routine, we are really required to include tattles, so include that in the R and then time oriented. Over what period of time do we want this little one to be working on this goal? When do we want to see the little one achieve goal or you know, how many times do we want to see them doing this within a week or during this specific routine? So there is a lot of conversation that happens when developing a goal with the appeal. And again, we shouldn't be going in and telling the family, this is what we are going to be working on, this is that we want to -- you know,, this is exactly what we are going to do, we really want do make sure that we are listening to the family and that they are participating in this process. And of course, families are going to feed some support, right? They are going to say, sometimes, well, you are the expert, you know, you have been doing this, can you -- you helped me, what do you think? And of course we are going help the family navigate through this conversation, but just keep in mind when you writing goals to try to ask some great questions to then get the appeal to be an active participant in that. 

>> Hey, Mary, how are we doing. A. Yeah. We had a couple of questions come in. One question about consent, and you may have mentioned this. But Joyce is wondering, how many days -- what is -- what consent is attained by ECI? How many days before they notify LEA and how long does the LEA have to complete the eval? 

>> So we are -- so whenever we are receiving our referral, if we -- there are a couple of things. If we are identifying that a kiddo needs further vision assessment or further you know, we are going to look into their vision a little further and maybe they have never seen a specialist and we have five days to refer them to see to see a specialist to get their vision attended to or to refer them to their PCP. If we get an eye report then we have that five days as well to get consent from the LEA and to work with them. And at that point the LEA is a part of our team and we are, our goal is to under Texas ECI and baby -- our goal is to get access to the medical documentation, working dark work, working, who work with the family and TEA and get all of that completed within the 45 daytime period, so that's what we are striving for, we are trying to get it done soon we can to get that kiddo started with services. Okay. One question we will get from Yvette, she was asking about -- let's see, read it correctly here. If services have to be, direct services or if they could also be consult services. She kind of hearing they need to be direct, from her case manager and was wondering about that and also if there could be any coteaching or TDIs can teach together, or if they need to be separate and she is speaking about that could also relate to -- OTs or any combination of the above, but, we will be getting to that in a bit. 

>> Yeah. So, to the first part of that question, it will really kind of depend on when you -- when you are there evaluating the kiddo and based on the kiddos' needs what you determine is appropriate for that little one in the visit. We have little ones for example that have services on the plan for maybe once every three months or once or three types a year. I think I have one currently in our program and the TDI is seeing them, the. TDI are seeing them three times a year so maybe that is what you mean, like as a consult, maybe that is answering your question, I don't know, but sometimes we have of course monthly, they are providing direct service and then coming in at other times maybe you know, three times a year, however and just to check in and see how that little one is doing and if there is a further need for services identified then they will do an IFSP meeting and Kriens that. In terms of covisits, absolutely you are able to do covisit, we love covisits also. We also kind of love working with our other experts on the team, covisits can be on the IFSP we just need to identify and provide documentation for why that covisit being recommended, how it is going to benefit the family and how it is going to benefit the child. And so there is actually a little section in our IFS.S that require us to document that. And also just when you are doing your notes, your progress notes, you can provide some documentation on that too, just as to why that is appropriate and why you are repping that. 

>> Just one more question that came in and Mike is asking if she supposed to refer to HHS before the eval is completed. 

>> Referred to HHS to the -- to the vocational program, the blind children's vocational program? 

>> I believe that's what he is referring to. 

>> So our case managers are assisting with that. I mean, you are welcome to do that too, obviously, but I know that the -- what they require is the Texas eye report, so that's what they need from us whenever we are submitting those investors the Texas eye report and the information on the appeal. I don't believe that I have ever been asked for the evaluation from the TDI, so as long as you have that Texas eye report you should be good to go with that and the case managers are helping with that as well so that could be a good thing to chat with your case manager about and see you know, just kind of touch base on that and help support each other through that. 

>> I hope that answers your question. 

>> Great, Jackie. I will let you continue. That's all we have for now. 

>> All right. Let me check my time because, you know -- okay, my goodness, we are flying through here. All right. So let's go through the next steps. So ten our service delivery begins and this is the fun part also, delivery with our little ones and working with the family and this is another requirement, another timely requirement, services services should begin within 28 days of so signing the IFSP, again that sounds like a really long time, radio submitting sometimes that is necessary for families and scheduling and things like that, but we really want to get in there as soon as possible. And then I am going make a little note about or say a little note about LEA registration because in the past registration has really impacted some of these timeline requirements, sometimes we will have services on the plan and -- because the family hasn't registered with the LEA they haven't started their services yet, and so when talking with one of my colleagues about this, I was informed that there is no rule that actually states that the kiddos can't begin services without registration being cleated. So the child does need to be registered, however service accounts begin before that. And I know I paid be you know, kind of blowing some people's minds because I know that this is something we are all -- we have all encountered and maybe that is the direction that you are -- that your school has told you to take, but apparently there is no rule that states that services can't begin. So this is great. This is gate news. I am happy to share that information to you that was provided to me about this, because the sooner we are able to get in, the better, the better you know, for these little ones that we are serving. All right. So services have begun. We are working with our families and we are following our coaching model, and so when the coaching model is kind of pushed out, I would say recently, but we have always been doing coaching with our families. This is a part of ECI, of who we are and what we all do. But these are just some of the criteria from the coaching model that we are required to make sure we are documenting when we are working with our families. So joint planning with families is important, when we are talking to them about you know, how did it go from your last visit? We are observing them and when they are doing the strategies kind of talking about how we need to tweak strategies. We are demonstrating new strategies. We are getting feedback from the family, kind of talking it through and now we are reflecting on that visit, you know,. Just, again, a lot of what you all are already doing, a lot of what happens organically during service delivery. And then we are joint planning again, we are talking about what would the family like to work on during the next visit, what is the priority for the next visit. And sometimes those priorities changes, sometimes whenever you go to a visit, something has happened within that past weekend, the family would really like to focus on that, so again just you know, really, really focusing on the impact that the family has in the team and the role that they play. There is also a coaching model that can be accessed on H -- under the webinars if anyone is interested in reviewing this. It is really helpful and also a part of -- a part of my role in ECI is in under -- kind of being the liaison between the DDH providers and specialists and I can share a progress note that has you know, all of these little sections included on the progress note, if that would be helpful for you to see I am happy to share that as well. 

>> Talking about progress notes, so these are the required elements on a progress note and also very important plug is why do we even bug you? Why do our ECI programs bug you so much for progress notes? Because we have to have them. We have to have them and also these are all of the things that should be included on a progress note. So the name of the child is really also important to include that child's -- the child's real legal name, sometimes we will receive progress notes that have nicknames of that little one on them. And it is just really helpful to make sure we are including that child's full legal name on the progress note. The name and discipline of the provider. The date, start time and total time of the visit. Because we are entering all of this into our state reporting database. The place of the service, the service type, obviously you know, the method as individual, group, the goal, what occurred during the visit? And the signature of the provider with the credentials. So these are all important elements on the progress notes. We want to make sure that we are kind of writing about what happened during that visit and that can kind of go back to the point that were noted on the coaching slide or on the coaching -- slide. So all of our services, as mentioned earlier are reported on a monthly basis into the state reporting system, and in our case we are reporting those in two places in our agency database and state reporting database and so having all of these required elements on the progress notes is extremely helpful an important so that we are making sure that we are accurately entering the information that is happening. We want to know what is occurring. The state wants to know also what is occurring. And then state reporting is time sensitive, so it is really helpful if you get your notes in quickly and please be kind to your ECI case manager or whoever is asking you for these notes and in some of the cases, me, be kind to us as we are only working to toll rules and regulations that are provided to us and we have to enter those into our state database before it closes for the month. There is a due date on that, we have to get them entered, and so we really ask that our progress notes be submitted to us by the third of every month. And so this way we are able to do a review, make sure there is hog that is missing on the progress notes, and then get them all submitted. For filing purposes. All right. So review. I am just going keep -- oops, I keep moving along my -- wherever my -- I see my face here and I keep moving it from side to side. So also during a child's service delivery journey, we are continuing to review their progress, right? We do have periodic reviews, at least every six months we have an annual evaluation to determine eligibility but we are really looking at that kiddos' development every month, you know, and maybe multiple times a month, however many times we need to, our case managers are meeting with the family, talking with them about their kiddos' progress, if any adjustments need to be made we want to make sure that their IFSP is fitting for their needs and is meeting their needs, and the family can request an evaluation at any time. If a family feels like their kiddo is needing some supporting gross motor they can request an eval for that, an so it is really important to our ECI teams are informing the family of their rights, right in so it is important that they know all of these things that they can have access to. And it is extremely important to note that no changes can be made to DHH or VI services without the teacher present. If -- I just going to raise it straight from here. If the DH. Or -- teachers without teacher present, the SC will obtain input, send the IFSP for review and obtain teacher signature. DHH/VI teachers must be present at annuals. You should be invited to all of the IFSPs. If for some reason you feel like you don't need to be at that IFSP, that's okay, if this is another IFSP that will address a different area. But we do need to get your input and we need talk to you about what we are doing with this IFSP meeting. You need to be in agreement on the IFSP plan and you have the right to request another IFSP meeting within five days of that first meeting if you disagree with any portion of the I am FSP. So really important to just keep in mind we are all a team, and your role is very, very important and we want to make sure we are getting -- we are getting your input eight time. And we can't make changes to the services without you, we need you. These are -- I keep doing that. These some of our -- the team members in ECI you will work with. So every -- every ECI case will have a case manager, and the case manager is working with that family on a regular basis. You know, we are having at least monthly contacts with that family but sometimes multiple contacts. We are talking about a goals, making sure the goals continue to be appropriate for that kiddo. We are talking about resources, 0 how is that family doing? Do they immediate any assistance with accessing resources. And our case managers are also empowering families to learn these systems, because our little ones are going to be with us until they are 3 and then the family is going to transition out, so we want to make sure that we are giving families tools for their toolbox and navigating systems when they exit our program, and help them to feel confident in using their voice whenever they are needing support, and they are speaking up and advocating for their child. We also have early intervention specialists who provide very special service called special ed skills training which is unique to ECI. This is a very beautiful service and not just saying that because I did it for so long, it is a really fun position and we get to work on all areas of development but we are really tying in social emotional and cognition and helping just to support that team as a whole, and we learn a lot from our experts on the team. And so again a very unique service to ECI. It is called SST, specialized skill training. We also have speech therapists, occupational therapists, physical therapists, of course our DHH and VI teachers. And then we work collaboratively with nurses and other entities. Anybody who else is involved in that child's care with consent and we are going work with them as well. We want to get buy-in from everyone and make sure we are not missing anything that is really important for that kiddos' daily routine and their development. And then transition. The bittersweet part of ECI. Hey, Mary I kind of see the chat flashing there. Yeah. There are a couple of things that came in. Let's see. Britney was just confirming that the VI teacher is a required member of an IFSP as well in Texas, and, yes, I will let you answer that but -- 

>> Yes. The answer is yes. Absolutely. Yes. Did I only say DHH? Apologies if I did. 

>> I am so sorry. I just lost the chat. I just wanted to also mentioned the OMM is a part of the -- I think sometimes VI services kind of include the O and M but, you know, with O and M, of course, is .. a part of that ECI team as well. I think that is it, right now. 

>> Yes. Absolutely. 

>> Thank you so much. 

>> Homonyms are a vital part of that team as well and I think she is right, we loop our own -- with VIs and the answer is yes. All right. So a transition, again our final steps in ECI and as we have talk about, our little ones age out of our program when they turn 3, which is very bittersweet and hard for us to say God buy but also you know, we are also looking forward to helping them .. in their continuing journey to make sure there is a seamless transition. So -- so we begin planning for transition around age 2, we are going to start talking to that family about what supports they are going to immediate as their child is aging out of ECI. And I am looking at any time. I have four minutes, all right. We are getting thereness we are getting there. And of course during transition our certified DHH and VI and O and M teachers as well play a vital role in this process. And so we are wanting to definitely make sure that you all are included in that. We need your input. Throughout all of this we need your input for these little ones. So as mentioned the transition begins, the conversation begins around age 2, so we complete those transition steps which is basically a plan for that child's exit from ECI services. We complete that at an IFSP meeting so preferably when the team is there we are talking to the family about transition and talk about what the family wants to look into. Perhaps the, they maybe want to put their little one in a day-care, private paid day-care or maybe head start program or maybe they want to look into other case management resources or private therapy for those -- for their child. So I will let these things we are going to document on the plan and before their child turns 3 we are going help the family look into those things, whether it be you know, a tour 0 at a local day-care or you know, a face-to-face meeting with the head start representative, but one of the really big things that we also do is help connect the appeal to the local school district should their child qualify and need services under special education. And so we complete a transition conference with the local education agency representative, to later than 90 days before that little one's third birthday and again that goal is to make sure that there is a seamless transition and there is no gap in services. So if that kiddo qualifies for special education, hopefully that evaluation has been done within that 90 day period, the ARD meeting is completed and there is a date set for the child to start their services. We have made the referrals to private therapy organizations or wherever else that kiddo may need go, that is -- we want to make sure all of that is in place before their third birthday. We should be invited and attend ARD meetings, you know, if our families are okay with that, we love to attend ARD meetings and get all of that information and really help support the family during that time, and again, make sure the family understands the importance of their voice and that they are their child's biggest advocate and help them navigate through that process. So let me see. Ah, I did it! I did it. So as you see, there is a lot that goes on in ECI and with our partnership with our local education agencies. This was a very quick general review, over an hour but I am happy to chat more with anybody if you would like to connect with me. Here is my e-mail address. This is my work cellphone. I am happy to chat my time and I appreciate your time. Thank you to the Texas school for the blind team for letting me come in and do this and it is good chatting with you all today. And I think -- I think we are good. I think I met my time limit, huh, Kaycee? 

>> Oh, you did great. 

>> Thank you so much, Jackie. And I want to get the code out to you guys in case you need to jump to. On April 8 we will have collaborating with families in the IEP process dash which is a fine education research and family support so you don't want to miss that. On April 12th yes literacy for little ones overview, Rene Ellis and Cathy Garza, lots and lots of early childhood this month. Check our happy hour website. For upcoming registration events. Again. The CEO for today your response to the evaluation that will be e-mailed to you at the registration website, you will enter the code and the CEU certificate will automatically generate on the end of that evaluation and the handouts and recordings from this and past coffee hour sessions are available on a link on our coffee hour page TSBVI -- once you are on the coffee hour page, scroll down -- to the archives. That's a link and take you to the recording and put in the chat information. On the evaluation received from ESC works there are two boxings, 10 and 11, you see additional comments you would like to share with the presenters, additional comments you would like to share with the event team, so please let us know in those boxes, the dates am times we are offering coffee hour this year and working through your schedule are a few other suggestions for future coffee hour times and schedules.