The original intent of this proposal was to collect data on all children who received services in the 1993-94 and 1994-95 fiscal years in all nine of the districts. This was found to be about 1800 subjects. It became clear that these were more, subjects than was feasible to review within the limitation of the grant's resources. In order to preserve the intent of the project while lowering the number of subjects to a quantity feasible to complete the chart reviews, data were collected from each odd-numbered TEIS client chart which had recorded the performance of a TEIS Intake during the time periods January 1 through June 30, 1993, and January 1 through June 30, 1994. In addition, we chose not to collect data from District 9 (the Memphis area) because of the selection bias of that region's procedures which at the time of the study almost exclusively enrolled only children who were in community based early intervention programs sponsored by the Department of Mental Health and Mental Retardation. Data were entered into FileMaker Pro 2.1 database files directly from the charts by one individual (LC) from 2/20/95 to 12/22/95. Services data not available in the charts by July 1, 1995, were not entered.
The data collection system was developed ta collect the data outlined in our proposal reflecting the practicality of what data were available in each district. The demographic variables were obtained from the Individualized Family Service Plan (IFSP), the Progress Notes, Central Intake Form or TEIS Staff. The demographic data are presented in Table One.
|TABLE ONE. Demographic Information|
|Age at Intake||Sex of Parent(s)|
|Current Age||Occupation of Parent(s)|
|County of Birth||Government Program Eligibility|
|State of Birth||Agency of Coordinator|
|Age of Parent(s)||TEIS District|
The Evaluations And Cost are presented in Table Two. All costs for evaluations listed below were flat rate estimates for each evaluation service. In the few cases where the cost estimate provided by TEIS was an hourly rate, the cost of two hours of that evaluation service was used as the flat rate, with the exception of psychology, where the cost of 3.25 hours was used. For all payers except TennCare cost was an estimate based on the TEIS payment rate from the given district for the appropriate year. If this information was unavailable, the 1994 TEIS established maximum payment rate was used. Where TennCare was the payer, cost was estimated using an average of MCO payment rates from the following TennCare MCO's: Access MEDPlus, Blue Cross/Blue Shield, HealthNet, Omni Care, Preferred Health Partnership, Prudential Community Care, TLC Family Healthplan, Total Health Plus and VHP Community Care.
|Primary Care Physician|
|Other Medical Specialty|
|Psychology--flat rate is equal to 3.25 hours|
|Cost of Professional Team Evaluation--The sum of the cost of each team member's evaluation|
|Total Cost of All Evaluations for Each Record|
|Number of Specialist Physicians Involved in Case--Obtained from Intake or medical records found in the chart.|
|Participants in Team Evaluation--Obtained from the team evaluation report in the chart|
|Payers for Evaluation Services--The information identifying the payers for each evaluation service was obtained from progress notes, IFSP's, TEIS district staff, or deduced from funding source eligibility and government program eligibility|
The variables related to services and goals are presented in Table Three. The data was obtained from IFSP, Service Provider Reports, TEIS Service Coordinators or Their Progress Notes.
|Date of the Initial IFSP Meeting|
|Professionals Involved in the Development of the IFSP|
|Services Received By the Client and/or Family|
|Setting of Each Service|
|First-Listed and Second-Listed Payers for Each Service Listed|
|Number of Service Hours (or Days of EIP) Per Month for Each Service|
|Total Number of Hours/Units for Each Service|
|Duration in Months for Each Service--Months of service prior to June 30, 1995 are not counted in the total, because data collection from cases still active during the research period began July 1, 1995.|
|Goals Specified on IFSP, e.g., Fine Motor, Expressive Language, Respite Care|
|Degree of progress Toward IFSP-Specified Goal|
|Date of Comment Related to IFSP-Specified Goal Progress|
|Degree of Progress Toward Desired Outcome When No IFSP Goals Were Specified|
|Date of Comment Related to above Progress|
The cost by service for each record is presented in Table Four. Cost was per hour of service with the following exceptions: transportation cost was per mile; special instruction cost was per 1/2 day of an Early Intervention Program when the service setting equaled Home and Early Intervention Program(EIP) or EIP alone; assistive technology cost was per item, e.g., hearing aids with ear molds. For all payers except TennCare, cost was an estimate. based on the TEIS payment rate from the given district for the appropriate year. If this information was unavailable, the 1994 TEIS established maximum payment rate was used. Where TennCare was the payer, cost was estimated using an average of MCO payment rates from the TennCare MCOs listed in the section on Evaluations and Costs.
|Cost Per Unit|
|Total Cost of Each Service|
|Total Cost (Charges) of Services for Each Record|
The variables related to the subjects' developmental delays are presented in Table Five. They were obtained from IFSP or Service Provider Reports in the Chart.
|Areas of Developmental Deficits, e.g., Fine Motor, Expressive Language|
|Functional Age Equivalent (AE) in Months|
|Chronological Age (CA) in Months|
|100 - (AE/CA)100 Yields Percent of Developmental Delay--Computer calculated.|
In a case where a language delay was recorded only in terms of level of delay, e.g;, mild, moderate, severe, etc., an estimated value was entered for AE in the formula above. A value was entered which allowed the formula to yield the average of the given range of percent delay that corresponds to the level of delay. This range of percent delay comes from a chart developed by the Vanderbilt University Child Development Center. The chart, entitled "Criteria for Percentage of Language Delay," can be found in the appendix.
The analysis plan is designed to answer 7 main questions:
In a six-month period, what services do children with disabilities receive? How many of those services do they receive?
Are some combinations of services more common than others?
What are the costs of providing services to the average child? How does this vary by type of service?
Do some combinations of services produce better progress toward treatment goals?
Who bears the cost of treatment? Do families depend on more than one source?
Do individuals with different means of paying for those services differ in the types and amounts of services they receive?
How have reimbursement patterns been influenced by the introduction of managed care?