The Division of Public Health / Early Intervention Branch has proposed a change in the service delivery model for the Infant Toddler Program. Currently there have been no new developments or announcements from the Early Intervention Branch.  NCOTA representatives are in dialogue with the EI Branch.  Keep checking this website for more information.  We also need YOUR input if you provide Infant Toddler Services. Please complete this survey: Infant Toddler Survey  (even if you completed an earlier survey). Keep reading for more information and NCOTA's statement about proposed changes.
 

 The model being proposed is called the “Primary Service Provider Model”. The EI Branch has provided limited information on the model change, but the model is based on three key concepts:

1. Teaming – If multiple providers are involved with one client, the providers along with the family/caregivers will have ongoing meetings/discussions related to the treatment plan and plan of care.
2. Coaching - with this model the parent is coached by the Primary Service Provider to carry out treatment with the child in the natural environment
3. Coordinating – – 1 person—the primary service provider--would be responsible for coordinating the team members working with the child. The PSP might be a licensed therapist or might not.

NCOTA has reviewed the proposal and contacted OTs who are EI experts and practitioners in other states where the model has been implemented. We have identified the following concerns:

1. Under this model, direct service provision by skilled practitioners is reduced. Therapists are expected to teach the PSP so the PSP can coach the family. How will the proposed plan ensure that children who need skilled occupational therapy actually receive services from a licensed occupational therapy practitioner? How do coached services comply with the statutory scope and responsibility of a licensed therapist?  
2. In the states where this model has already been adopted, it is common for the PSP to be a non-licensed individual. Who decides when direct therapist assessment or therapy intervention is needed?
3. There may appear to be cost savings by reducing therapy utilization, but limiting direct therapy services means the state can no longer bill Medicaid for most services. With the federal share of Medicaid funding no longer available, won’t this proposal increase the financial burden on the state to provide EI services? Where will funds come from for therapy professionals to be compensated for their services under this model?
4. IDEA Part C (the federal legislation authorizing EI services) states that the IFSP team determines what is in the best interests of the child. In states where this model has been implemented, the role of the IFSP is often diminished or bypassed.

NCOTA supports evidence based practice, quality care, and collaboration with both family members and other health professionals. NCOTA is also committed to ensuring that practices and services be consistent with the professional and statutory standards of the profession and fair to practitioners.
 
NCOTA urges all members to stay abreast of this issue and check the NCOTA website for updates. We also need your help—if you provide EI/ITP services, please participate in our data gathering survey here.  NCOTA member feedback along with our collaboration with EI staff will help OTs be well prepared to move forward in a strong role in whatever model NC finally adopts!