Caring for Our Childen (CFOC)

Chapter 8: Children with Special Health Care Needs and Disabilities

8.4 Developing a Service Plan for a Child with a Disability or a Child with Special Health Care Needs

8.4.0

8.4.0.5: Development of Measurable Objectives


The individualized service or treatment plan for a child with disabilities or a child with special health care needs should include services aimed at enhancing and improving the child’s health and developmental functioning, based on measurable, functional outcomes agreed to by the parents/guardians. Each functional outcome objective should delineate the services, along with the designated responsibility for provision and financing. The development of the plan and its goals and objectives should not only include the child care agency staff, but all of the professionals, including various therapists and/or consultants, who will have the responsibility to assure its implementation.

With the assistance of the child’s service coordinator, the caregiver/teacher should contribute to the assessment of measurable outcome objectives (service plan) within the child care setting at least every three months, or more often if the child’s or family’s circumstances change, and should contribute to a full, documented case review each year. Reevaluations should consider a self-assessment by the caregiver/teacher of the caregiver’s competence to provide services that the child requires.

Service reviews should involve the child care staff or persons providing the intervention and supervision, the parents/guardians, and any independent observers. The results of such evaluations should be documented in a written plan given to each of the child’s caregivers/teachers and the child’s family. Such conferences and lists of participants should be documented in the child’s health record at the facility.

Each objective should include persons responsible for its monitoring.

RATIONALE
When measurable-outcome objectives form the basis for the service plan, the family and service providers jointly formulate the expected and desired outcomes for the child and family. By using measurable-outcome objectives rather than service units, all interested parties can concentrate on how well the child is achieving the outcome objectives. Thus, for example, progress toward speech and language development assumes more importance than the number of hours of speech and language therapy provided.

Further, measurable outcome objectives constitute an individualized approach to meeting the needs of the child and family and, as such, can be integrated into, but are not solely dependent upon, the array of services available in a specific geographic area. The measurable-outcome objectives will provide the facility with a meaningful framework for enhancing the child’s health and developmental status on an ongoing basis.

Regularly scheduled reassessments of the outcome objectives provide the family and service providers with a framework for anticipating changes in the kind of services that may be needed, the financial requirements for providing the services, and identification of the appropriate service provider. The changing needs of children with disabilities and/or special health care needs do not always follow a predictable course. Ad hoc reevaluations may be necessitated by changes in circumstances.

COMMENTS
The defining of measurable objectives provides a useful structure for the caregiver/teacher and aids in assessing the child’s progress and the appropriateness of components of the service plan. Though this principle should apply to all children in all settings, implementation, especially in small and large family child care homes, will require ongoing assistance from and participation of specialists, including those connected with programs outside of the child care setting, to provide the needed services.

Many facilities that provide intervention services review the child’s progress at least every three months. This is not a comprehensive review, but an interim analysis of the progress toward meeting objectives and to decide if any modifications are needed in the service plan and its implementation. Generally, the entire plan and the child’s progress receive a comprehensive review annually. It is likely that caregivers/teachers will need training on development of goals and the means of assessing progress.

It is assumed that staff members who interact with the child will have the training described in Pre-service Qualifications and Special Training, Standards 1.3.1.1-1.3.3.1, and Training, Standards 1.4.2.1-1.4.6.2, which includes child growth and development. These topics are intended to extend caregivers’/teachers’ basic knowledge and skills to help them work more effectively with children who have disabilities or children who have special health care needs and their families. Caregivers/teachers should have a basic knowledge of what constitutes a disability or special health care need, supplemented by specialized training for children with disabilities and children with special health care needs. The number of hours offered in any in-service training program should be determined by the experience and professional background of the staff.

Training and other technical assistance can be obtained from the following sources:

  1. American Academy of Pediatrics (AAP);
  2. American Nurses Association (ANA);
  3. National Association for the Education of Young Children (NAEYC) and its local chapters;
  4. National Association of Pediatric Nurse Practitioners (NAPNAP) Child Care Special Interest Group;
  5. National Association of School Nurses (NASN);
  6. State and community nursing associations;
  7. National therapy associations (e.g., National Rehabilitation Association, Association for Behavioral and Cognitive Therapies);
  8. National Association of Child Care Resource and Referral Agencies (NACCRRA) and its local resource and referral agencies;
  9. Federally funded University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD);
  10. Local children’s hospitals;
  11. Other colleges and universities with expertise in training people to work with children who have special needs;
  12. Community-based organizations serving people with disabilities and/or special health care needs (e.g., Autism Society of America, United Cerebral Palsy Associations, The ARC, Easter Seals, American Diabetes Association, American Lung Association, Epilepsy Foundation, etc.);
  13. Zero to Three Policy Network.

The state-designated lead agency responsible for implementing IDEA may provide additional help. If the child has an IFSP, the lead agency will be responsible for coordinating the review process. If the child has an IEP, the local education agency will be responsible for seeing that the review occurs. If not, a less formal evaluation process may need to be conducted.

Assessments may be the financial responsibility of the IDEA Part C State-designated lead agency or other organizations (see Standard 8.4.0.6). Funding available through implementation of IDEA Part C should provide resources to assist in implementing the IFSP.

TYPE OF FACILITY
Center, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
8.4.0.2 Formulation of an Action Plan
9.4.2.1 Contents of Child’s Records
10.3.4.5 Resources for Parents/Guardians of Children with Special Health Care Needs
10.3.4.6 Compensation for Participation in Multidisciplinary Assessments for Children with Special Health Care or Education Needs