Program for youngest Hoosiers faces massive backlog
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As many as 1,500 Hoosier babies and toddlers are missing key development milestones — caught up in a massive and unprecedented backlog in the state's early intervention program that provides services such as speech and physical therapy.
Why it matters: The first three years of a child's life are a crucial window in which their brains are still developing. For children with developmental delays, early intervention can have a significant impact on their ability to learn new skills and can increase success in school and life.
Driving the news: Indiana's early intervention program, First Steps, is so far behind in providing timely services as required by the Individuals with Disabilities Education Act that it's at risk of federal sanctions.
- State lawmakers writing the next two-year budget have proposed increasing the funding for the program from $18 million to $25.5 million, but advocates are concerned it won't be enough.
- The appropriation is based on a study from 2018, so it doesn't take into account the past five years of inflation and wage pressure.
State of play: The demand for services is increasing, while the program is losing therapists and other service providers, Christina Commons, First Steps' director, told Axios.
- A study commissioned in 2018 found that the rates First Steps paid to providers were 35% to 60% lower than regional market rates.
- The percentage of kids waiting more than 30 days for services has grown from 2% in 2013 to 17% in 2021.
What they're saying: "We had providers leaving, saying: 'I really love this job, but I just can't afford to do it anymore,'" Commons said. "The rate was an impediment to retaining qualified staff."
How it works: Every state is required to provide early intervention services to children with developmental delays or disabilities and their families, from birth to their third birthday.
- Families arrive at First Steps through a referral, generally when their child has missed a developmental milestone or has a diagnosed medical condition, such as Down syndrome.
- After referral, each child goes through an evaluation to qualify for services.
- The most common services include physical, occupational and speech therapy.
The latest: The Family and Social Services Administration, which administers First Steps, scraped together enough funding earlier this year to raise rates by 14% to 64%, depending on the service provided, but it will need the proposed state funding bump to maintain those rates.
Yes, but: Even with the new rates, the program is struggling to retain providers, according to Mariann Frigo, an occupational therapist who has worked as a First Steps provider for 25 years.
- "They brought up people's salaries but it's still not competitive and we're still losing people," she said.
Context: First Steps providers make home calls and can spend hours on the road, often only seeing four or five kids in a day. And if a family cancels or forgets their appointment and isn't home, the provider doesn't get paid.
- There's an emotional toll, too, Frigo said. Providers are in families' homes every week — sometimes for two years or more — so they often watch as a family struggles to make ends meet or care for a medically fragile child.
- "It can be very lonely and very challenging," Frigo said. "As hard as it is, we do amazing things and kids actually catch up all the time."
What's next: Lawmakers have until April 29 to finish the next two-year spending plan.
- The latest revenue forecast shows the state has an extra $1.5 billion than previously expected.