ROUGH EDITED COPY

2016 EHDI Annual MeetingTopical Session 4Pacific Salon 2

HOW DOES YOUR EHDI INTERVENTION SYSTEM MEASURE UP? STATES’ EXPERIENCES USING THE JCIH EHDI SYSTEM SELF-ASSESSMENT

9:40 a.m.March 15, 2016

CART SERVICES PROVIDED BY:ALTERNATIVE COMMUNICATION SERVICES, LLC

PO BOX 278LOMBARD, IL 60148

* * * * *This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

* * * * * [ Captioner cannot hear presenter ][ Applause ]>> NICOLE BROWN: Thanks. Hi, everybody. My name is Nicole

Brown, and I'm the EHDI Coordinator in Minnesota, or one of the EHDI Coordinators in Minnesota. The last presentation is a little hard to follow, a hard act to follow, so I appreciate everybody here. We also have done this presentation one time at our DSHPSHWA meeting, so I was glad to see there was going to be some people in the audience today so that's good. So thank you.

So I'm going to -- this presentation today is a little follow-up from a presentation that we did last year, where we talked about developing this tool based on the Joint Committee on Infant Hearing, JCIH, simultaneous from 2013 that really focused on intervention. We in Minnesota had talked about wouldn't it be a great way to assess our state looking at how are we doing with all these recommendations? And we thought an organized way of looking at how our state is doing might be a good plan.

So we talked about the development of that took last year. This year we're going to talk a little bit about different states have used it but I'll give a little background of the tool, as well.

So here are our presenters today and I'm going to have each one of them introduce themselves as they come up and talk about their state.

So today, I'll talk again a little bit about the self-assessment tool background. We'll have the panel talk about the process that

they used when they use the tool and some of the lessons learned, and then have some time at the end for some discussion about how your states may be able to use the self-assessment tool, as well.

So this little girl up here at the top is my daughter Linea. This is -- the top picture is when she was six months old. She is profoundly deaf, and I think we as EHDI Coordinators often think of the 1-3-6 and we're like: Pshew! we're good. She was well within the 1-3-6 intervention, but as a parent and all of you know that's just the very beginning. We were just beginning. This is her at the bottom. She's now in third grade and doing really well but we often need to think about beyond the 1-3-6, right? What is the real purpose of EHDI? And really it's about those optimal outcomes, and JCIH, the joint Committee on Infant Hearing also believed that as well so they wanted to come together and look at recommendations for states, thinking about those long-term outcome kinds of things, and in quality improvement, we're all working on, you always hear what gets measured, gets done.

So JCIH also wanted to think about looking at those, shouldn't we be measuring those kinds of outcomes and the factors that impact it? So how do we get there? How do we think about looking long-term and outcomes for our kids so they can reach their full potential? Well, for us in EHDI we've really been using quality improvement to help us work on one of our other huge issues in loss to follow-up so it would make sense that we would use quality improvement methods for this, as well. So you may be familiar with this model for improvement here, and really, when we think about self-assessment, it's part of that quality improvement foundation, really assessing our needs and gaps. You can see. We really need to figure out: Where are we now? And where do we wish to be?

So our hope is that this self-assessment tool will be the beginning of your discussions in your states or your programs to think about: Where are we? And what are our needs? And what are our gaps?

So what is self-assessment? It's a reflective process where stakeholders can explore their state's EHDI Program, and then work collaboratively to develop strategies to enhance policies. So again it's looking at needs and gaps, capturing system's vulnerabilities, and then as you'll see with a lot of our examples, it also helps to identify some strategies that you might want to test in your quality improvement projects.

So I need to say a special thanks to these folks so Candace Lindow-Davies was a National Hands & Voices President when we first developed this tool. She also is in Minnesota, which was great because it was really her and I discussion at the very beginning thinking about, wouldn't it be great to have this tool to help us really evaluate where we're at with these recommendations. We knew though if we developed a self-assessment tool that we'd need a lot

of input from stakeholders, parents and experts.So I want to also thank Diane and Alyson from NCHAM. They also

were very helpful in the development of the tool and then JCIH themselves, to really look beyond the 1-3-6 and think about outcomes and think about Early Intervention systems.

And so Christy Yoshinaga-Itano was really helpful in conveying to us some of the discussions that happened at JCIH and the meaning behind the recommendations so we could take those recommendations and plunk them into a tool.

So the tool development, this is a little bit of what I talked about last year, but a little background in case you didn't hear it. We modeled the JCIH self-assessment tool after other tools that have been developed. Really kind of with a 1-4, 1-5 rating scale of where do you think your system is at? We also got stakeholder feedback from National Hands & Voices and from JCIH and from different states, and as you'll hear from Anna Paulson, thank you to our Minnesota team who really helped review first drafts of the tool and said: This is way too long. Or, this doesn't make sense. And went from Version 1 to where we're at now as Version 5.

And then testing of the tool. So again, thanks to other states, we have these four states plus two additional states that have tested the tool and used the tool within their states.

This is what the tool looks like. So you'll see JCIH has 13 goals related to Early Intervention systems. You'll see at the top the goal. We also learned that we needed to put a rationale of sort of what JCIH was thinking within a tool and we took the information word for word from JCIH, because we know that they've had lengthy meetings talking about just which word to use so we didn't really want to interfere with any of that. We took word for word from JCIH. Then under each goal there was recommendations so each one of these 3.1, 3.2, are each one of the recommendations from JCIH. What doesn't show here is that even underneath each one of these recommendations, there are sub-bullets, if you really look at JCIH, to talk about how do you get there? What does it look like? Those were included in first drafts of the tool but it got to be really lengthy so we kind of ended up just with this. So I'm the going to turn it over to Anna to talk about how we used it in Minnesota.

>> ANNA PAULSON: Hello, I'm Anna Paulson and I'm from Minnesota. A few of us are in here today. If you notice I work for the Commission for deaf/DeafBlind and hard of hearing Minnesotans and that's a different agency really to have this specific assessment coming out of. But the reason that I am here is because in Minnesota they have what we call a collaborative and the collaborative started in 2007 and that's a group of stakeholders, 50, who came together and decided to align the initiatives, the priorities and the resources of their agency group to see if we couldn't together make outcomes, big changes for kids. So in that

collaborative is the Department of Health, Department of Education, Department of Human Services, Pacer, Hands & Voices, district teachers, audiologists, speech-language pathologists. It's a whole group of really committed stakeholders who will actually go through those hard discussions about what we need to do to make it happen together.

That collaborative is broken into four groups, the birth to age 5, two school age groups and the transition group and these are most of the representatives from the birth to age 5 group so these are the people -- I failed to add our northern voices, our auditory oral listening spoken language program and MSAD, our School for the Deaf also were in this group but those are our team members so you can see they're our big hitters, our decision makers, the people who are out with families but also the people who are invited to statewide meetings. We looked at that tool and it was very big, like Nicole said, it was big. It was consistent with what JCIH wanted but for us it was pretty overwhelming so then we broke it apart, talked about some of the definitions, had some discussions about how agencies would define each of the goals, and then we decided we're going to identify a few of those goals as our priorities. Is that me?

I'll stand back here so Nicole and Candace sent out the tool via email, and we looked at it and everybody got to vote. Goal 1 are priorities. Goal 4 are priorities. Which one of those are the ones Minnesota wants to start with? So after much deliberation, we went back to Goal 1. And we went back to Goal 1 because it really is the part that we felt kind of connected to families and where we felt that Minnesota really needed a little bit of improvement.

But then we started talking about: Well, that's a national goal, and some of the terminology within there doesn't really exactly define what's happening in Minnesota. So let's go ahead and have the opportunity to tell our story. So again, through email, people put in their stories. So Kathy Anderson from the Department of Ed, our low incidence projects, put in what her definition of Early Intervention is. The Department of Health put in their pretty chart of what they see happening now, and what we came up with was an agreement about what Goal 1 meant, and where we felt like we needed to improve.

We also moved our rating system because our original rating system put us further into the not quite ready for prime time, and after some discussion about what was happening, we were in the just-beginning phases of this goal, so we felt a little bit better once we had defined and resolved what had to happen.

Then we thought, well, okay, so we want to do this materials review but is this the group that does that? Is it feasible for this group to take that challenge on? Or is this something that maybe only the Department of Ed does or maybe only the Department of

Health does? And no, we decided if we wanted to develop a mechanism to make sure that resources were available, disseminated to all rural, urban, all families, met the cultural biases that we wanted to make sure were not there, were available in different languages, then, yeah, it was feasible that this would be the group.

And, of course, we made it a priority, as well. So then we kind of had to back up and we had to say: Well, we've got our goal, we've got our mission, but how does it fit into that long-term quality improvement? Will we be able to measure outcomes if we do this activity? Because we had an activity but did we know that it was going to be a sustainable outcome that we could measure? So we backed up and did this drivers diagram and really defined what was the root of this issue, and how would we take this issue and make a sustainable outcome for families.

We broke into groups, and now we have work groups that are working into a deep dive on the content of the material, an overview of how -- what format is it available in? And then how will we review it every year to make sure it's sustainable to change?

So Minnesota lesson learned, takes a long time to review one Goal. We thought we could do 13 in one sit-down. We ended up doing one in 10 sit-downs, so you actually have to have all of your stakeholders at the table. You can't just assume that one agency can own this project. And that it's going to take some time to agree that just because the wonderful heads of JCIH agreed on these terms, we also had to have some agreement in our state on what these terms meant.

And then we really do need everybody to commit to then the ongoing process of ensuring that we hit the goal, assess the goal, and then sustain it.

We even have a "thank you" slide.>> MARCIA FORT: Good morning. I'm Marcia Fort, and I am the

EHDI Coordinator for North Carolina, and a one of the things we trade to do as we were looking at this presentation was make sure, all of us used some of the same processes, so we trade to not make all of our presentations exactly the same. So I picked out some different pieces, even though we all did approach this from kind of a strengths and weaknesses, and impact metrics, and some of the quality improvement tools together.

So we, too, began with bringing our key stakeholders together. Many of these stakeholders are also active on our EHDI Advisory Committee in the state, and we have very committed stakeholders and are very grateful to all of them. We also have, within our Early Intervention, Part C Early Intervention, in North Carolina, we have two groups that focus on Part C. One of them is directly related to providing services to children with hearing impairment, so we have both the infant-toddler program, and the early learning sensory support program for children who are deaf or hard of hearing. So we

made sure we had both of those groups at the table.We do have an active School for the Deaf, and we made sure we had

them. We also included our Department of Public Instruction, so in North Carolina, Part C is housed within the Department of Health and Human Services, but Part B and beyond is housed in our Department of Public Instruction, so again, we're looking at long-term outcomes, so we wanted to make sure we had the over age 3 stakeholders at the table.

We also have beginnings for parents of children who are deaf and hard of hearing, or hard of hearing. And we have a fairly substantial military population in North Carolina, so we made sure that we brought that perspective in, because things are somewhat different for those families.

Audiologists, cochlear implants, University training programs, and EHDI Program.

So our first meeting, we had about 25 or 6 stakeholders present at our very first meeting, and we worked with Sharon Ringwalt who happens to be North Carolina's Technical Assistance person from ECTAC. And asked her if she would be willing to facilitate the meeting for us. As most of your state's Part C programs, our state was in the middle of their strategic planning, so it was perfect timing.

We also had a new Part C Director in North Carolina, so the timing to do this was really good in our case. So we started the day with an overview of the self-assessment tool. We had sent the materials out prior to the meeting, but all of our stakeholders are very busy people, so we were fairly certain they had glanced at it, but we wanted to make sure they understood what we were trying to do. And then we divided our group into three smaller groups, and each of those small groups went through the assessment tool for 4 of the goals. And so we did that for the first part of the day.

And then we took a little break, and then we did a gallery walk, where the other two groups walked through the work that had been done, so everybody that was there was able to add to all of the goals when we reviewed those, so everybody had the opportunity to do that.

Then we did a little debrief, where we had some open discussion and worked on prioritization of goals. We did have an all-day meeting that first day. And throughout that day, our stakeholders really were very vocal about how interdependent all of the parts of EHDI -- the 1, the 3, have to get us to the 6 -- and they were very, very vocal about that and made some very good points.

So that led us to some of our priorities and the time lines. We prioritized Goals 2, 3, and 4, which those are copied directly out of the Tool. But the key thing that kept coming up was timely access, so I have rephrased those at the bottom. Timely access to service coordination skills with the expertise to work with children

who are deaf and hard of hearing. Timely access to diagnosis that leads to the referral, and timely access for children who are deaf or hard of hearing with additional disabilities, so we ended up really focusing on the "timely" aspect of what was going on.

So then, we needed to have another meeting, and our Advisory Committee co-chairs had suggested having a retreat where our Advisory Committee members and our EHDI staff members would spend a day working together. So we expanded that a little bit, and included the stakeholders who had come to the first self-assessment meeting, and did have an all-day retreat.

And on that day, because of the first meeting and the emphasis on the interdependency of all of the processes, we took the time to first split that group, and that group was 41 people. So we grew pretty dramatically.

We split that group into 3 parts, and reviewed existing materials and activities that were going on that we had information about. And then we went into a part of the day where we completed a strengths, weaknesses, and opportunities. We made a conscious choice just to eliminate "threats" for the sake of not confusing people. Strengths, weaknesses and opportunities for screening, and in North Carolina we do an inpatient screening and an outpatient re-screening so we're one of those states that does two screenings before diagnostic.

So we did a strengths, weaknesses, and opportunities for the screening and re-screening process, another analysis for the diagnostic process, and continued to build on just reviewed what we had done at the first meeting related to intervention.

So out of that, we came out with a fairly substantial list of opportunities that exist, which is good. Our next steps are going to be to work to develop some collaborative quality improvement teams to identify some specific strategies on selected goals, increase utilization, or make sure we continue to utilize, evidence-based systems change practices. We are housed in public health, and public health is definitely making a move toward population-based activity, so we are looking at systems change in addition to family by family.

And we definitely want to utilize our Advisory Committee and other stakeholders to do a periodic re-evaluation of our goals, and establish program priorities moving forward.

So as -- we learned many lessons. One is, I would strongly encourage use of a facilitator to help out. It takes the target off your back, for one thing. And -- but as part of the development of the tool, Nicole and her group developed an evaluation of the tool itself, and so to be a little different than the other state's presentations up here, because our lessons learned are very similar to theirs, I have displayed the results of that evaluation of the tool itself, so we had overall, people were very pleased to have a

tool like that that guided the evaluation. They felt like the tool's purpose was clear. That the format made sense, that it was very valuable to have the collaborative assessment, with all of the -- we tend to get siloed in our own little worlds, and it was nice to have everybody reviewing it together, that we did have the right stakeholders at the meeting. There was some variations, there were a few people who would have preferred to complete that assessment by themselves. A few that wanted to complete it over multiple meetings.

But again, more, a higher percentage, said it was feasible to complete at least the first run through this evaluation in one meeting. It was a long meeting, but -- and pretty much everyone said using the tool is valuable, and that it helped them understand the strengths and weaknesses in their state. So overall, we had a very positive experience. We're continuing to work our way through that and hopefully we'll have some great success in the near future.

>> PAM DAWSON: Good morning. My name is Pam Dawson. I'm the director of an Early Intervention agency in listening and spoken language in the state of Maine and I'm actually representing a multi-state collaborative that used the tool. Maine, New Hampshire, and Vermont came together and we used it in a little bit different tape of a format. Although some individual EHDI state QI initiatives came out of our collaborative, our primary purpose for using the tool was to look at the system of care on a Regional basis and try to identify some unmet need, so potential places that we could be sharing resources and also to just sort of test the waters on what a collaborative relationship between our states might look like.

And we knew that there was unmet need and that there was a need to start trying to share resources because as we all know hearing loss is a low-incidence disability, and in three states with a lot of rural populations and relatively low population counts, we have over -- less than 200 children identified annually in all three states together. We have rural populations, and it's difficult, especially for our rural families, to have access to both information and qualified providers, as well as parent to parent support.

So our participants included representation from all three states, from our EHDI Programs, from our Part C programs, and Early Intervention providers. We were lucky that again. Because we're small states, and our state agencies, state government, are a little bit smaller, we were able to get leadership at the table.

And in terms of representation from Early Intervention, because of the way our states are structured -- and I'll get into this more in a little bit in a few minutes -- by having representation of our organization, Hear Me Now, an organization from Vermont, New Hampshire, as well as our state School for the Deaf in Maine, we

really were able to get representation from a large majority of the EI providers in our three states.

One way that we used the tall, the framework, that was very, very helpful for us was to help us decide what materials and resources we needed to gather to study. As you can imagine, when you have three different states, three different ways of providing Part C services or intervention, we had a lot of resources that we were gathering together.

So we used a combination of in-person and virtual meetings. We've met three times in person in the state of New Hampshire, which was sort of the middle ground for us, and lucky for the people in New Hampshire. And then we also had five meetings over ZOOM video conferencing, which is a virtual meeting platform. And if any of you have tried it, you'll know that it's really kind of fun, because it's sort of like the Brady Bunch and you have all these different pictures, little windows of everyone that's part of the meeting and then the person that is talking gets big. So you can actually see them and feel like you're corresponding with them.

It worked very well. Meetings are also recordable, which was very helpful. And then to conveniently, or efficiently, gather all the resources that we needed to, we used Google Docs and Google Drive. We made folders for -- I didn't tell you. So we also realized that we couldn't possibly address all of the goals so we chose some focus goals and we chose 1, 2, 3, 4, and 7 and then we established drives, Google Drives and put all of our State resources in each of those drives so that we could study them further.

And we used, like, a task list to help people identify where we were going to put them. And that's what it looked like.

So once we gathered all the information, we sort of took a step back, and we said: Okay, what are we going to do with all this information? Looked at the recommendations, and decided that we would conduct a gap analysis, and look at it specifically through the family's perspective. What is it like from a family who's trying to identify resources on a Regional basis? And what's out there, if we take a step back that way. And we decided to use the recommendations of the tool as a way to frame possible improvement strategies, and just to pick one and start small.

So we also came up with a voting strategy. After we went through all the goals that I just mentioned, we went back and decided that Goal 1, recommendation 1.2, which you can read right there, developing a mechanism for ensuring families have access to information, was what we wanted to focus on. And our voting system was a little bit different.

We were voting to identify opportunities for Regional collaboration as our primary purpose, so we first looked at where each state stood using the tool in the process. Nothing in place, just beginning, et cetera.

New Hampshire and Vermont were both just beginning a materials review, and a process review, of how they were educating families after diagnosis, and Maine has a fairly well established process in place as a result of a memorandum of understanding between our State School for the Deaf and our Part C agency, but some of the materials that were being used, some of the participants felt could use some updating so it pelt felt as though that was a good place to start. Some people had a process in place. And there were materials that everybody needed.

And that voting, down at the bottom there, where it says opportunity for Regional collaboration, those are just the numbers of people that voted, and this was the one that received the highest rating.

So we decided that our next step, pending Grant funding, is going to be that we will have a Regional web resource that is not creating new information, but is helping families to direct themselves to existing National resources that have been put through some sort of a rubric or a process where families and other participants in the collaborative had the opportunity to rate and rank how they feel those materials and those websites meet the criteria, the JCIH 1.2 criteria, of being complete, well-balanced, non-biased, et cetera.

And then that Regional page will have links to each of our state-specific resources. And it will also have links to parent to parent support on a Regional basis so that parents that live in rural areas don't have a lot of access to other parents, will have a broader community that they can access.

So I'm putting a plug in here, I'm working towards funding for the second phase. Haven't found any yet, so if anybody knows of any out there, please speak to me.

Lessons learned, as I said, one of the reasons that we did this was not only to look at the system of care, but also to just sort of see what a collaborative might look like on a multi-state basis so we actually used a collaborative inventory called the Wilder inventory to just sort of pre- and post say how we were doing as a collaborative. These are results from the post-inventory and people felt like it was much needed, that we all recognized there's an unmet need and the opportunity to share resources, and that we set a reasonable goal.

It was very helpful for us to share perspectives on all three of those different tapes of agencies that were represented, and it was a respectful process.

Ways to improve, these are related as much to the way that we conducted the collaborative. As I said, we used a virtual meeting software for some of our meetings, and we discovered that it might be a good idea to set some rules for virtual meetings before we actually started the process, because we learned that it's much easier to become disengaged when you are not face-to-face with

people, and that you might not know it, but if you are answering your emails while you're looking at the screen, we can still hear you typing on your keyboard.

[ Laughter ]So that respectful meeting participation at a virtual level is

something that we would do at another time. And continuing discussion that we all have I think that work in this field is how to come together as stakeholders, acknowledge our personal belief systems, and then move on from there in a collaborative way.

There's a couple of other representatives of our collaborative here and I just wanted to make sure that I took a chance to acknowledge them. So Linda Hazard is here, as well, from Vermont. And then we have Karen Hopkins from the Maine School for the Deaf is here, too.

Who's next?>> KELLY HERMANNS: So good morning, my name is Kelly Hermanns.

I'm the state EHDI Coordinator for Georgia. After listening to the talk last year about this tool I knew that this was something that we could bring back to Georgia and use. Right now, the timing is right for Georgia. We're very interested in our outcomes for our children who are deaf and hard of hearing. One, the EHDI Program is doing a long-term follow-up study as well as an evaluation on our kids and collecting language outcomes on our children who are deaf and hard of hearing. We have a another collaborative that's Georgia pathway to language and literacy and they're looking at what can we do to remove barriers so all children who are deaf and hard of hearing are on the pathway to grade level reading, since we know that many of our kids as much as they might be getting the intervention services aren't still achieving that huge mail stone in their life.

I also have a Commissioner who is very into our program and interested in our program, so now is the time to move and make changes that are outside of my program that impact the kids that we do identify within EHDI since Part C and our other interventionists don't reside within EHDI. I can't make those changes, I need other people to make those changes and believe in those changes to make a difference.

So like everybody else, before we started -- I started thinking about this it's like who needs to be at the table? So pulled a bunch of our State programs. We had the Part C Coordinator, as well as the Provider Relations Manager. Our SKI-HI Coordinator was present, as well as Program Manager who is also in this room, Alice, and we had myself and my Director at that time. We also wanted to make sure that families were represented, so we had some representatives from Hands & Voices, Guide By Your Side, and then the Department of Public Health also has a Family Engagement Coordinator, so I wanted her to be a part of that as well since this

impacted our other child health programs.Some external people that we had was again Georgia pathway to

language and literacy since they're trying to do it on a statewide basis as far as improving our outcomes for children. Atlanta speech school, a private interventionist as well as the auditory-verbal center a private interventionist provider in the State of Georgia.

So unlike the other states, I broke ours down into three 2-hour meetings. I'm personally someone that I don't have the attention span for a full-day meeting. I get really flighty. I start talking very sarcastically and go off on tangents myself, so I can't facilitate a meeting effectively if I'm going off into la-la land myself, so we were able to, I think we were the only state that was able to get through all of the goals and write the goals. I'm also as much as I can get flighty I'm also a very task Manager and as we start going down a rabbit hole that's not necessarily relevant to the topic I'm like hey people, let's come back to what we were supposed to be discussing. It's very easy in the world we live in and how passionate each and every one of the stakeholders are at the table to go off into different directions so it's very important you don't go down those rabbit holes because they're very easy to go down.

Another thing we did was establish and agree to the rating definitions that were already outlined in the evaluation as Nicole had described earlier on, so the ones were: Nothing in place, just beginning, making good progress, and established practice. I used a private rating scale. As much as all of our stakeholders are coming to the table but there are still some strong opinions in the room, and some biases in it so I wanted to make sure that people didn't feel influenced by the person sitting next to them and that the information would only really be shared with me and unless I start interpreting handwriting I'm not going to know what you wrote sort of thing.

I also as far as our rating process, because Georgia is basically Atlanta has everything and the rest of the state really doesn't have anything and the rest of Atlanta, or Georgia, is very rural, some people kind of did two ratings. They did an Atlanta metro one and then they did a statewide one but as far as the purpose of this evaluation tool I used the state wide one. So that's how we did that. So I basically again gave them the materials ahead of time so that they could kind of review and become familiar with.

Some of the stakeholders at the table were already familiar with the tool. Our representative from Hands & Voices is sitting on the parent education committee with the CDC, where basically they're also taking the JCIH supplement and breaking it down for families to be meaningful for families, so she had a very good perspective sometimes when we had some of those fuzziness as far as what the definition actually did mean. I really enjoyed the conversation, so

we basically read through it, read the goal and then read the sub-goal and then had a conversation about it as far as what we're doing.

And it was really interesting and really wonderful to see all the different opportunities that we had as far as cross-collaborating and hopefully breaking some of our walls down as far as some of our training, so that everybody could be on the same page and hopefully improve our messaging so that not one provider saying one thing and the next provider is saying the complete opposite because it's very confusing for families when they have multiple providers giving different messaging so if we can all collaborate and have the same trainings hopefully that will improve consistent messaging. I discovered other agencies and other groups that were also working on some of the very similar goals that I didn't know about myself as the EHDI Coordinator, because again, sometimes in EHDI, you get caught up on the 1 and 3, and you hand them off and you're like: You do your thing now. You don't realize all these different great things that we can again cross-collaborate as far as a state. So again all the people at the table self-rated themself.

The first two meetings were set to doing the self-rating of the overall goals. I then averaged the ratings and then at the third and final meeting, I basically put these sticky, those big white easel Board things, with the goal and then the score of how we scored what the average was, and then we were like okay, let's go through the overall goal and determine where we want to go next.

So everybody again got to rate, it wasn't private, but they used the little stickies on the top 3 that they wanted us to focus on. I have to say I had some nightmares going into this meeting because again we have a lot of strong opinions and I was like oh, God, hopefully they're at least focused on one or two and we're not all over the Board and then what do we do if no one can agree on what direction we want to take us. Being realistic we set the top 3. Luckily they all fell within goals 1 and 3 on the JCIH supplement and then again because each goal has sub-goals I know realistically we can't achieve 16 things in the next year. I'm someone you do a few things -- I'd rather do two things really well than 16 things mediocre.

So let's really dive into those sub-goals and figure out where we want to do it. So again we did the same what's it called, the same voting kind of schedule, so they sat there and put stickies so you can see 3-1 had the most and it made it very easy for us to sit there and come upon what we wanted to do.

So we have now basically 5 different activities or 5 different goals that we want to work towards as far as with Georgia.

We were pretty early, our late, in doing this. We didn't get started until probably around new year's time. I think it was January-February so we pretty much wrapped up our strategic

planning. Now we have the framework to develop it and I just need to really get some of that thought down on papers and look at some of the notes that we were able to take as far as what our next steps be there and then organize some subcommittees as far as actually getting the work done because it's always easy to plan. It's the next step in getting the work done that sometimes can be the barrier. And again bringing all these people together.

Some of our lessons learned, it's helpful to have all our primary intervention stakeholders. I kind of wish I would have brought in our children's medical services and Children First, which is kind of our gateway into all of our programs. Since those families are sometimes going into these other providers, too, and we want to make sure again back to messaging that we're all on the same page with what we're doing. As much as children medical services might be more providing the medical care and not the direct intervention as far as speech-language therapy or language therapy, I think it would have been more important to also have them at least a part of the conversation to know what was going on, and what our challenges were.

And again I think it was -- we didn't spend so much time focusing on the definitions but I do think it was very important that we all did agree on the same what we were rating, because it was kind of easy sometimes, depending on what chair you sat in, to kind of look at the goals in a little bit different of a light, so making sure that everybody's voting on the same thing, and that their rating systems, and we're all rating the same things.

I also did kind of forget, what I also like that we have is we also have a baseline for Georgia. We know where we are right now so once we do make some of these changes we can at least go back and self-rate ourselves again. It might not have to be in the same sort of formalized event since if we do it with all the same stakeholders and can do it to see if we are making progress. Is what we're doing making a difference in the lives?

So thank you. I appreciate your time.>> NICOLE BROWN: Is there any questions? Just one comment about

what Kelly was saying. For one example when we were looking at definitions our group even had a tough time deciding what we mean by Early Intervention? Do we mean Part C Early Intervention? Capital EI? Does that include the deaf mentor program? So what exactly do we mean by Early Intervention so like all of us talked about even coming up with what does that really mean, that JCIH is talking about? What is the definition of that? So some good discussions.

And I as an EHDI Coordinator learned a ton. I thought, after being in the system for quite a long time, I learned a lot about Part C that I didn't know. And I thought, you know, the materials that the Department of Health provides are pretty comprehensive and they're pretty great but when you ask either interventionists from

our listening and spoken language school, or the School for the Deaf, both of them agreed that, no, that didn't cut it. So that was good information.

[ Laughter ]So other people, it sounds like there were some people that were

part of the process in these different states. Any comments anybody else wants to make? Yeah?

>> My name is Alicia Favila, and I reside in Texas, and I spent 10 years as our State Coordinator for Deaf and Hard of Hearing Services birth to 5 on behalf of the Texas Department of Education, and I left in 2014, and we partnered up this Fall because one of the things that I did in my tenure was establish what is our State EHDI ` for Texas.

And so they had me back in the Fall to actually facilitate the instrument, if you will, the supplement, and that discussion. These folks for the post most part, many of them have been working together for some time but we also had some new comers so all of this was new, I guess I would say, in terms of conversations at that EHDI advisory level.

But what we did was we had them do their own self-analysis before they came. And they gave us great feedback about it, because it was long, but they were able to really give their own perspective without being influenced one way or another.

And then we spent the afternoon together, and I'll tell you, we planned 3 hours and it took 4. But we had some discussions, some background on the supplement, and then we had them break out randomly. Where in their EHDI Advisory Committee they have work groups, we didn't want them to stay in the work group because they know each other pretty well, and they have a pretty significant and specific focus, so we wanted it to be very multidimensional, if you will. And so it was just kind of 1, 2, 3, counted them off and grouped them and then they each reviewed certain goals in their small group and charted their strengths and needs, or opportunities for improvement and then we shared it with the large group and we had them go back then after that discussion and reassign their priorities, and I suspected it. We talked about this beforehand. But the priorities changed.

And so I think that the thing to keep in mind is that you can have -- there's such richness in being open to that multiple perspective in order to get at the end goal which everyone wants but we can't all know everything there is to know about a specific topic or avenue or ways it might be received by the consumer so I would encourage that concept of collaboration and you keep revisiting it because as you begin to implement things you're going to have to make adjustments along the way and test things where you can in front of families or in front of the provider who's at that 3-foot level with the family, there's some value in being open to knowing

that this is all a process and that's where the learning happens, is in the process, not the end result.

>> NICOLE BROWN: Linda?>> LINDA HAZARD: So I would just like to give you a little bit

of the Vermont perspective. Just before we started the collaborative, our Vermont Center for the Deaf and Hard of Hearing, which provided services, where the provider of the Early Intervention services in our school based services, and also housed our residential School for the Deaf went into bankruptcy. So we were all in a bit of a panic mode in September of 2014. Within six weeks, the Agency of Education and Agency of Human Services came together, and we were able to make sure those services continued with a private organization, which continues today.

But having said that, we realized as part of this collaborative, we had a wonderful opportunity to really look at all of our services for both, our Early Intervention and our school based services, and begin to do some quality improvement in those areas. So it has been a really rich experience, and just one other comment: Maine, New Hampshire, and Vermont, I know when everyone thinks of New England is you think of us as very similar. We have extremely different personalities between these three states, and it has been just a great experience to come together and see the perspectives and see the different lens.

So I'm hoping we continue to have some funding to be able to continue our collaborative.

>> NICOLE BROWN: I want to mention that the self-assessment tool again it's in Version 5. I think it still says "draft" on it, but I uploaded it for anybody to use. I think it was helpful, I think to have the states that used it sort of connect with Candace or I just so we know kind of who's using it and if anyone has any suggestions for changes or anything, I think that would be great. Yeah.

>> I have a question. Could you talk a little more about facilitation? So it sounds like some of you, the EHDI Coordinator facilitated, or you had an external person facilitate.

Did one of those work better than another? Or is there sort of a specific type of person or type of facilitator that seemed to really be able to do this well?

>> ANNA PAULSON: This is Anna from Minnesota. I started by saying that it's unique that I come from the Commission for Deaf, DeafBlind and Hard of Hearing Minnesotans, and I think that was -- that's actually a benefit to our collaborative, is that I actually don't represent one of the Big 4. My background is from the University of Minnesota, so I actually didn't come from any of the Big 4, and I think that's what I do for the entire collaborative, for all the four work groups. I'm merely the facilitator and I'm to come to all meetings with no opinion.

I actually took some facilitation courses when I first started

this job just to make sure that I could stay neutral and, you know, of course, I'm a teacher by trade to some of that comes out but I try really hard to stay in that zone and it sounded like some others have facilitators that aren't one of the big stakeholder agencies. So it's important.

>> We also used an independent facilitator and I would add too this is such a big tool and there's so much detail that it helps to have someone who is a bit of a tasker and keeps you from going down rabbit holes and moving forward once you've identified the goals you want to be working towards.

>> As much as I facilitated myself I wish I would have had a facilitator because I wasn't able to self-rate us because I got so wrapped up in making sure people were on point, I rated us on the first and second and I was like, I'm not even going to go there. I have enough votes on the table. What's one more at this point, so...

>> I'll weigh in, too. I would strongly encourage a facilitator. It was nice that we had somebody that was not intimately involved with our own players in the field, but had a really strong knowledge of Early Intervention to help with that.

>> Thanks. I'm Jack Roush, an audiologist on the faculty at UNC Chapel Hill and I currently Co-Chair the EHDI Advisory Committee for North Carolina and I would like to put in two plugs. The first, just underscoring what Marcia mentioned about the opportunity to bring together the EHDI Advisory Committee with EHDI staff and other stakeholders, because a lot of those people are volunteers. Sometimes they don't meet, have an opportunity to meet, all of the staff, because they're across the state.

I thought that was very valuable. The other thing is I would like to put in a plug for students as EHDI stakeholders. If you're not already doing this, I would strongly recommend reaching out to the universities in your state. We have some amazing young people going into these fields in speech-language pathology, audiology, deaf ed, special education. We have 170 students at this meeting, and so please reach out to them. Some of them need Capstone projects or projects that they need to do for a training Grant, or lend but a lot of them are just genuinely interested and you can at the same time contribute to the next generation of people who will get involved in doing this work.

>> Maybe one of them wants to take the tool and put it into a final form.

[ Laughter ]Anyone else?>> I think I would just offer that even though I am in the state

of Texas, since I've left my position, I've started my own consulting business, and much of that is around consultation and strategic planning, to support EHDI systems of care so if you guys

are interested and you want to talk with me after, I'd be happy to do that.

My consulting business is called: Original Score Consulting, and we're also offering coaching for administrators, and mentoring for Early Intervention providers, and a ton of eLearning that's coming out, too. So just as a I guess collaborative opportunity to support your efforts.

>> Any other comments from our panel group? I think the next step of the tool is probably finding it a home. It shouldn't belong in Minnesota, probably. So kind of belongs to all of us, so we'll have to keep looking for that.

Thank you, guys.[ Applause ][ End of session ]

* * * * *This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

* * * * *