News Article Details

Fewer East Texas children receiving state, federally funded Early Childhood Intervention for disabilities, developmental delays

Tyler Morning Telegraph - 10/30/2017

Oct. 28--The number of East Texas children receiving services to address developmental disabilities has declined at a rate almost twice that of the state and was disproportionately high among black children.

The findings came out in a report released this month by Texans Care for Children. The report details the state of Early Childhood Intervention (ECI) services in a 23-county Northeast Texas area.

Between 2011 and 2016, enrollment in Early Childhood Intervention services in Northeast Texas declined by 23 percent from 1,896 to 1,458, despite the overall population of young children remaining flat. Statewide, the decline was 10 percent in that time period.

The decline disproportionately affected black children and the area saw the steepest declines in Cherokee, Henderson, Bowie and Smith counties.

"It's deeply concerning to see that so many babies and toddlers in Northeast Texas are missing out on the help they need to learn to walk, swallow, communicate with their families, get ready for school, or meet other goals," said Stephanie Rubin, CEO of Texans Care for Children, the group that completed the report.

The report builds on a 2016 statewide report and an August 2017 report about Early Childhood Intervention in North Texas.

ECI is a statewide program for families with children, from birth to 3 years old, who have disabilities and developmental delays. It is provided through a combination of state and federal funds.

The services are provided to families on a sliding scale, with families paying between zero and the full cost of services, which could exceed $800, per month, based on their income bracket.

Early Childhood Intervention professionals include speech language pathologists, occupational therapists and assistants, physical therapists and assistants, social workers, counselors, nurses, psychological associates, dieticians and early intervention specialists.

In ECI, the therapist goes to the family and works with the child and family in their natural environment whether that is at home, at a relative's house or at a child care center.

The children's policy organization attributes the declines to several factors including cuts in state funding and Medicaid reimbursement rates, the withdrawal of ECI contractors and the elimination of Child Find outreach positions that helped educate community members about the programs.

Since 2011, state appropriations for the ECI program have dropped from $166 million in fiscal year 2011 to $148 million in fiscal year 2018.

In the 2011, 2013 and 2015 legislative sessions, the state reduced ECI appropriations, according to the report.

In 2015, Texas legislators also reduced the Medicaid reimbursement rates paid to providers of speech, physical, occupational and other therapies to children with disabilities, according to the report.

This year, legislators restored 25 percent of the Medicaid funding cut in 2015, but some people are concerned a new state rule that changes the way children's therapy providers are reimbursed will erase that gain, the report states.

In this year's session, lawmakers also increased the appropriations for the remainder of 2017 and for the 2018-19 biennium. However, they did not fully fund the anticipated growth in caseloads for the biennium, according to the report.

The 2018 appropriation for ECI programs is still $18 million lower than the 2011 appropriation.

The cuts matter because it places a greater strain on the local ECI contractors, according to the report.

In 2014, 22 ECI contractors, which was almost half the state's total at that time, experienced financial shortages and used $3.9 million in other funds from their organizations to pay for children's ECI services.

Of those 22, seven have since closed their ECI programs, according to the report.

Locally, the Andrews Center in Tyler closed its ECI program effective Sept. 30, 2016. The Andrews Center had managed the ECI program for more than 20 years, serving almost 300 children in a seven-county area.

Andrews Center CEO Waymon Stewart said at the time that the funding formula for the program had changed and the center could not continue to provide it without taking a big loss.

"We stayed in the program, trying to make it work and trying to balance the budget," Stewart said at the time. "The longer we stayed in, the more we saw that we were going into the red."

The closure of the Andrews Center program and delays in the state being able to secure a new contractor meant East Texas children went without ECI services, some for several months.

By Nov. 1, 2016, the state had entered a contract with Community Healthcore in Longview, to provide the ECI services to children in the seven counties previously served by Andrews Center.

Community Healthcore already provided those services in Upshur, Gregg, Rusk, Marion, Harrison and Panola counties.

However, it still would be several months until ECI services would resume for some children.

This gap in service can create problems for children, some of whom can backslide in their development.

It can also create gaps in communication with families who need the service or a loss of confidence among doctors who refer the services, the report found.

Their statewide research shows that enrollment declines after a closure because of challenges with communication with families, the time needed to hire and train new staff and community knowledge and trust surrounding ECI.

For local families who have their services restored, they are more thankful than anything.

Kimberly Brown, 47, a small business owner in Lindale, is well aware of the need for and benefit of ECI services. Her 2-year-old daughter, Kennedy, initially was assessed by the Andrews Center in February 2016 and was found to be more than 60 percent developmentally behind.

Because of that she received occupational therapy and specialized skills training through the Andrews Center until September 2016, when the center ceased to provide those services.

At that point her therapy stopped and Ms. Brown said she placed a lot of calls to the state because it is a requirement for them to provide ECI services. Kennedy went five months without services. However, because a big part of ECI is helping train parents to help their children, Ms. Brown used the skills she could to work with Kennedy during the interim.

In March of this year, Kennedy began receiving ECI services through the new provider and Ms. Brown said she is very pleased.

"She would not be where she is right now without ECI," Ms. Brown said. "We've just been extremely pleased and happy with (it) ... and we feel like she's getting everything that she needs."

Kennedy participates in speech therapy and specialized skills training now. She met all her goals for occupational therapy and was able to stop that.

"It's just amazing the progress that she has made," Ms. Brown said. "Of course, I know every child is different, but for us to have a child that we basically were told initially that she was going to have all these issues, just to see her thriving and working so hard and making progress, it's just amazing."

Kallie Foshee, 30, of Lindale also has seen the benefit of ECI with her 2-year-old son Beau. Beau has a fine motor delay and started receiving services in May. When he was referred, his speech was not very good and he had some trouble picking up and manipulating objects.

A specialized skills trainer comes to their house once a week and works with him for an hour. They practice things such as eating and picking up toys and placing them in a bucket, basically anything to make him use his fingers and his hands.

"He's just shown like a world of difference," Ms. Foshee said.

Her desire is to see more funding so the provider can hire more employees and help more children like her son. Child advocates at the state level agree.

Ms. Rubin, the CEO of Texans Care for Children, said the state's kids and parents deserve better.

"We encourage the Legislature to restore funding and make sure that little kids with autism, speech delays, Down syndrome, and other disabilities get the support they need," she said.



By the Numbers

This chart shows the number of children enrolled by county in Early Childhood Interventions in 2011 and 2016 followed by the percentage change in ECI enrollment from 2011-16 and the percentage change in the population under age 3 (the age group served by ECI) from 2011-15.

ECI Enrollment Enrollment Change Population under 3

County 2016 2011 2011-2016 2011-15

Smith 339 240 -29% 3%

Gregg 314 296 -6% 0%

Rusk 68 64 -6% -9%

Cherokee 104 56 -46% 1%

Anderson 80 40 -50% -4%

Henderson 143 89 -38% 3%

Van Zandt 83 60 -28% -1%

Rains(ASTERISK) 19 9 -53% -6%

Wood(ASTERISK) 43 49 14% -2%

Upshur 77 47 -39% -7%

Source: Texans Care for Children Spotlight on ECI in Northeast Texas


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