Improve caseload numbers for staff-the notion that cases will keep increasing and children are expected to be served within a time frame has to correlate with the no of staff to serve.

The notion of if this is not a good fit for you consider leaving should be changed to what can we do to improve or make things better needs to be embraced.

Feedback and follow-up on what is being done to improve or increase our numbers should be shared with staff.

How do we get there?

Not sure? This is an outcry that has been on for a while, but no actions have been taken? The agency needs to listen and act on the outcry of the staff that has been working hard and holding on hoping that some relief is on the way but nothing shows up.

Where is the deadlock?

Probably on the salary-Improve the renumeration or pay to get more people to work for this agency that serves needy children.

How do we re-enforce the disability act without increasing the workforce as needed? The number of children that needs our services have grown tremendously. More families are moving to this area that need services. Families are paying taxes and this should translate to the workforce that provides the services.

How can management help?

Management is doing a great job trying to support staff to beat deadlines. Is this helping translate to the actual need for more staff or showing that we do not need more workforce when staff is hurting? Is management cognizant of how hard staff is working to meet their demands? Supervision should not be for comparing how much work other team members are doing but looking overall on what can be practically done in a 8hr shift. Alot of our staff work over 8 hrs.

We need a survey on how many staff members work overtime to meet expectations without documenting the extra hours.

Areas that can be considered for improvement to save us time as service coordinators:

1. Follow-up of services is taking a lot of our time. At the moment when we put a request of services, we hardly get providers to offer parents. It will take lots of follow-up and time to email individual providers to serve.

2. Can we have admin staff help enter data forms and EI services into the system once they occur if we come up with a list to input those dates.

3. Admin staff can also help with putting out provider request forms once IFSP completed.

4. Helping with writing and mailing trying to reach letters using improved specified templates provided e.g. please use template 1, 2 or 3.

5. Can we have a monthly generated list for timelines eg transition, IFSP reviews lists due this month for us to print and use to schedule and complete tasks. Would save us going through the whole caseload report weekly.

Lastly can we have a team meeting monthly for updates and just to have space to air our views.

2.      When I first started years ago, we had regular staff trainings as a group on the basics of what we do…how to write a good functional (not skill-based) outcome. How to guide the conversation in developing IFSPs. Basics of child development/milestones across all developmental areas.  The overall quality of our interactions with families and consistency of practice has suffered since we pulled back on these. We need to make sure everyone has a good working understanding of the basics.

3.      Standardized onboarding by role by people or teams who know how to do the role they are onboarding for.

4.      Supervisors should have eyes on their staff annually/semi-annually to see how they conduct an evaluation, guide and IFSP development meeting, etc.  Just reviewing the paperwork does not give the full picture of strengths and needs to aid in staff development and puts the burden of identifying and remedying shortcomings on co-workers.

5.      Simplify family experience.  Right now, families often tell their WHOLE story at intake, again during EE, and again at IFSP development.  Intake call could be pared back to gathering basic info: parent concerns (but NOT a mini evaluation gathering detailed specifics-often this kind of information is no longer true or not needed by the time the EE actually happens), enough medical history to be reasonably sure there isn’t an EC we are missing (clinicians can get a thorough medical history at the EE), and logistics of how the ITP works and the evaluation process.  Then ideally, EISC attends EE gathers information, and then is able to complete the IFSP with the family at the end whenever possible…since they have been gathering information through the EE, the “developing the IFSP” part can usually be finished in 10-15 minutes, rather than subjecting the family to a whole other appointment where they have to repeat much of the info that was gathered at the EE.  This would help both the family experience and 45-day timeline issues, and save staff time bc no need to complete additional staffing forms and find time to staff cases between EE and IFPS development.

6.      Along those lines, the Child-Family Assessment should be started at intake.  Not with the goal of completing it, but anything that is shared during the intake call can be added to the assessment form and passed on to the evaluation team, who will add to it and pass on to the EISC (if not attending the EE).

7.      Look at more useful Child-Family Assessment tools to use rather than the one we are currently using (refer to ITP policy/procedure for recommended tools)

8.      Organize administrative supports so that as much as possible, people are doing mostly the work that only someone in their role can do.  Boost administrative supports to handle more of the completing/filing/printing of family forms, managing the logistics of appointments like confirmation calls/texts/emails.  Just like we have been copying Lisa Carson on EDDs so she can do whatever data entry needs to happen, we could copy an admin person/listserv for all the doscusign forms that are generated at the EE/CFA or IFP so when they are returned, they can handle making sure they end up in the right folders, what needs to get printed gets printed, copying sec III/signatures into the IFSP, etc.  Over a recent time study I did, I spent nearly 1/3 of my time on all of these kinds of tasks.

9.      Dedicate an admin support person to AT (inventory management/forms, cleaning, transporting AT between offices and to/from families) to assist the clinical staff involved with AT. They can be cross trained to support other needs when AT needs are slower.

10. Minimize redundant paperwork.   Information on the Sec III/eval report gets repackaged on the staffing form, Functional Skills form, COSF.

11. Convert more of the temp positions to permanent and/or increase the pay associated with the temp positions (especially clinical) to increase likelihood of filling them.

12. Utilize clinical staff to provide services (even if on a modified or limited basis) to families who do not have providers available in their area.  Sending to clinic or offering only virtual are not equivalent and defeat the entire purpose of our program. I also think it’s important for us as clinicians to keep a hand in clinical practice on an ongoing basis to keep up our skills.  Many have been trained in coaching but have never actually provided services within that model.

1.      The prominent gateway to receiving referrals is via incoming faxes.  Request the launch of eFax.

a.       send@mail.efax.com pilot was a success in August 2022.

b.      The faxes were received and stored on the shared drive.

c.       Delegated staff receive notifications of their receipt via Outlook.

d.      Recordkeeping is whole; copies can be made and edited by staff as needed.

2.      Admin Requests include faxing RUFs, HIFs, DSS requests for MRs and Evals, Acknowledgment Letters, etc.  Such routine tasks are numerous and take staff away for significant durations, preventing processing other tasks that only require electronic handling, i.e. Data Forms that are, on frequent occasions, time sensitive.

3.      With the eFax capability, Admin Support will be less encumbered by being away from their desks, including awaiting fax confirmation, and can dedicate desk time to expedite Data Forms and printing/filing processing.

B.     Create a dedicated mailbox for Progress Notes.  With a dedicated mailbox, Admin can access the mailbox and process as items are received.  Recordkeeping is whole.

C.     Bi-Annual Admin Meetings:

1.      Update staff of new or revised processes, and request feedback of those processes.

2.      Maintain consistency of processes

3.      Plan for backup support for scheduled leave.

4.      Review CDSA’s templates to ensure compliance with NC correspondence regulations.

5.      Current year’s accomplishments and goals for the next year.

6.      Brainstorm:  Develop an on-boarding and shadowing program to improve the training of newly hired members.

Always put in service time after entering the date of service or that will disappear, too.

Finally, you can click once on a child's name, then click on "Diagnosis Codes" on the right to quickly get to the data entry form. Same goes for EI, addendum, or anything else you need to add.

As I said at my visit with you Dr. Corbitt, a look at the processes from referral to exit is necessary for all staff to understand all the steps, how can we assist in the next steps and abide by the families we serve. Look at our foundation. Improve our foundation to meet the times. Paper is time and electronic records is efficient. by improving out foundation we will have a guide to follow for onboarding.

Intake: what is the concern and how does it impact child participation (outcome)

EE: gather the information and the concern and how it impacts their day

IFSP: enter the info the team gathered, enter any improvements/issues the family reflected on after the EE (strategies)=one continuous flow. lessening work load on all and having the family be HEARD by all (not repeating)