Eligibility criteria among the nation's most restrictive

Missouri is one of only three states which require a minimum of a 50 percent delay in one developmental area to be eligible for early intervention services. All other states have broader eligibility criteria, or have a reduced criteria for children with delays in multiple developmental areas. As a result, some children have not received needed services and utilization and costs of DESE's Early Childhood Special Education program may have increased. (See page 10)

Improvements could be made in evaluating children's needs

Improvements could be made in evaluations of developmentally delayed children through the use of a multidisciplinary team approach. This approach has not been fully implemented because of financial concerns of independent providers. Providers have been concerned about inadequate pay rates and a contract stipulation that providers performing a child's evaluation would not be allowed to perform ongoing services for that child. (See page 13)

Some children not receiving

all needed services

Some eligible children did not receive all needed services, or received services at a reduced level, because of a shortage of providers. This situation has occurred because of inadequate provider pay rates, the lack of reimbursement for travel, and the SPOEs' inability to secure local funding to supplement provider pay.  (See page 15)

Coordinators have difficulty servicing cases adequately

Coordinators at program offices reviewed could not devote adequate time to most clients and, as a result, service to clients suffered because of heavy caseloads. Coordinators have experienced heavy caseloads because (1) DESE underestimated coordinator workload in its request for proposal process, (2) the lack of providers created inefficiencies, and (3) data system issues have existed. (See page 19)

Delays, potential overbilling, and documentation issues addressed

With DESE's implementation of new SPOE contracts in February 2006 and resulting changes made in the delivery of services by intake and service coordinators, client intake delays have been reduced through redistribution of the intake workload. In addition, SPOEs have been required to employ service coordinators and are responsible for supervising them which has eliminated potential overbilling and resulted in improved documentation of cases. (See page 22)

Consultant contract not cost-effective

In 2004, DESE entered into a 3-year, $1.21 million contract for regional "consultant" positions, which provide guidance and technical assistance to the SPOEs. However, if DESE had employed the consultants, the services would have cost DESE approximately $860,000 over the same time period�a 3-year savings of $350,000. (See page 27)

Total funding not known

DESE spent $23 million on the program during fiscal year 2006. However, this amount did not include Department of Mental Health expenditures on the program. Mental Health personnel have not tracked program expenditures because they have not been required to do so. Mental Health officials estimated the department incurred approximately $1 million in expenditures for the program during fiscal year 2006. (See page 28)