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The Missouri First Steps Program offers early intervention to children between
the ages of birth and three-years-old. This time period is a critical window of opportunity for therapy services as research has shown over and over again. that early intervention is the most effective, and least expensive.
This program’s efforts are not duplicated under any other agencies or organizations. Private insurance does not cover these needed therapies. Unless parents have the financial resources to pay for the services, children with delays, autism, Down syndrome, spina bifida, blindness or hearing impairment will have to wait until they are three years old to begin receiving help.
Eliminating this program will rob our state’s youngest population of their chance to achieve their potential, while at the same time delivering to our public schools children requiring more services then the schools will have resources to help.
The purpose of First Steps is to help families improve their child’s development, learning, and participation in family and community life.
- 8,041 children and families received specialized services from Early Intervention (EI) providers across the state in fiscal year 2004 (at a cost of $2,976 per child in FY 2004).
- Approximately 95% received the services in their homes or at community locations, such as daycare or childcare facilities.
Why is First Steps important to Missouri families?
In the spring of 2004, 1,400 families responded to a First Steps family survey conducted by the Division of Special Education (DSE).
- 97% said EI services provided families with ways to improve their child’s development.
- 91% agreed the services positively benefited their child.
- 91% stated EI services had a significant impact in their child’s development.
As a part of the survey, families provided comments regarding their experiences with the First Steps system. Typical comments include:
- “Thank you for providing such a wonderful program for our family. Our son is a completely different boy from last August thanks to First Steps.”
- “I credit the First Steps program for the progress my daughter has made over the last two years. When faced with devastating news of problems your child has after birth, it’s nice to know that an agency will help us every step of her life and guide us in teaching things at a slower pace.”
- “My child is now on par with other children his age. It’s incredible in some areas he is advanced! Thank you!”
- “I believe Parents as Teachers was crucial in the beginning before my son turned two in noticing delays. Early intervention (from age 2-3) with First Steps was so extraordinary in my son’s development. Although he qualified for special services for his first year of preschool, he probably won’t qualify for his 4th birthday year.”
What improvements have been made to the First Steps system?
The Department of Elementary and Secondary Education (DESE) is committed to a system that meets the needs of families. Based upon the input of families, providers, and state agency partners, the FS system has evolved from a “state agency” system that was delivered by the Department of Mental Health and Department of Health and Senior Services to a regionally based system with private providers. The current structure contracts with agencies that are familiar with the needs of young children and their families. The major components of the system include:
- a Central Finance Office and centralized data system,
- 24 System Points of Entry (SPOEs) allowing a consistent delivery system throughout our state,
- a standard curriculum for professional development for all service providers, and
- a credentialing system so that providers in the system are trained to understand the philosophy and requirements of the First Steps system. Based upon continued consumer input, DESE continues to improve and enhance the system.
Changes initiated on July 1, 2004, include:
- expanded administrative and accountability roles for SPOE directors,
- employment of service coordinators by the SPOE to improve the quality and accountability of services for families,
- establishment of a Regional Interagency Coordinating Council (RICC) to allow local participation of key individuals in the regions to assist the SPOE regional office with and other regional priorities such as identifying hard to reach families,
- establishment of a Peer Review Committee of professionals to ensure consistency in evaluations and services for children,
- inclusion of system of Performance Standards in SPOE contracts with incentives/penalties for performance,
- expanded use of distance learning for training to allow providers better access and consistency of information, while improving cost effectiveness and efficiency in training, and
- evelopment of a web-based child data and provider billing system to streamline data reporting and payments.
Why do we have First Steps?
In 1989, with the reauthorization of the Individuals with Disabilities Education Act (IDEA), the U.S. Congress created an opportunity for states to partner with the U.S. Department of Education to create a system of EI for children with disabilities and their families. Missouri has participated in this voluntary program for fifteen (15) years.
Why is DESE involved?
The U.S. Department of Education oversees the state implementation of IDEA for children with disabilities ages 0-21. Part C of IDEA requires states to identify a “lead agency” for early intervention services birth to age three. In 1984, the Missouri General Assembly passed legislation to create the Parents as Teachers (PAT) program targeting all families of children birth to age five. Since DESE administers PAT and IDEA, it made sense to designate DESE as the lead agency for Part C. Governor Ashcroft signed an executive order on May 24, 1989, designating DESE as the lead agency.
How is it funded?
States that implement the IDEA Part C regulations are entitled to federal funds to support the program. In 2005, the First Steps program is estimated to cost $27.2 million dollars. Funding to cover those costs will include $7.7 million from federal funds, $2.7 million from Medicaid and $16.9 million, from state general revenue.
Who is eligible?
Missouri is one of eight states having a restrictive eligibility criteria for its early intervention system. In Missouri, children between birth to age three with the following conditions are eligible:
- a diagnosed physical or mental condition associated with developmental disabilities such as Down Syndrome, spinal bifida, cerebral palsy, or very low birth weight with additional complications at birth, or
- a developmental delay that is half of what would be expected for a child of that age in one of the following five (5) areas of development: cognitive, communication, adaptive, physical, or social/emotional.
Missouri’s system is designed to identify only children with the most significant disabilities.
Approximately 76% of children that leave First Steps at age three receive early childhood special education services through their local public school.
What are Early Intervention services?
The First Steps system is designed to provide families the tools they need to help their child to be successful. Early Intervention services include occupational therapy (OT), speech therapy, special instruction, audiology, physical therapy (PT), assistive technology, and other supportive services outlined in IDEA. The system uses professional providers such as OTs and PTs to be consultants and coaches for families. These providers are trained by First Steps to help families use learning opportunities that occur naturally in everyday activities. Services are not intended to be delivered in a therapeutic or “medical model,” but rather support the child and family in home environments and community.
How do families become involved?
If a family suspects that their child may have a disability, they can contact DESE or one of the 24 SPOEs located throughout the state (1-866-583-2392). A service coordinator (SC) will then begin to gather evaluation information that already exists or is needed. If the child is eligible, a service coordinator will work with the family to develop an Individualized Family Service Plan (IFSP). If the child is not eligible, other community resources and programs will be shared with families. Families play an important role in their child’s development. DESE believes that parents truly are a child’s first teacher.