Nassau County Comptrollers Office

An effort to control costs in the Nassau County Health Department’s Early Intervention Program (EIP) appears to have borne fruit: services to children are up and costs to the county are down, according to an audit of the program released today by County Comptroller Howard Weitzman.

“Early intervention programs nationwide provide a critical social service by evaluating and providing treatment for developmentally and physically disabled children from birth to three years of age,” Comptroller Weitzman said. “If we are going to have enough funds to provide this vital service, the program must be efficiently run.

“It is heartening that our audit found evidence that the county’s Health Department has been ‘doing more with less’ in running the Early Intervention Program. Although more children are now enrolled and total program costs have risen in the last four years, the county’s contribution to those costs has declined.”

In 2003, nearly 6,600 children received services under the federally mandated program, about 400 more than in 2001. The program, which receives federal and state funding, had overall costs of $46.8 million in 2003. Yet the county’s share of those expenses fell from $20.5 million in 2001 to $16.3 million in 2003.

The EIP’s mission is to identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised and provide for appropriate intervention to improve child and family development.

Despite the declining costs to the county, the audit, which covered the years 2001-2003, found several areas in which improvements could be made that would result in greater efficiency and savings.

“One of the program’s goals is to minimize the need for special education. Yet both countywide and statewide, the audit found there is a serious lack of measurement of costs and benefits,” Comptroller Weitzman said. A 1997 State Comptroller’s audit of early intervention programs noted that the NYS Health Department had no system for measuring the extent to which program goals had been achieved.

“That is still the case, unfortunately,” Comptroller Weitzman said. “The county should not wait for the state, but rather should develop its own program to monitor early intervention and measure whether it is achieving its goals.”

The audit also warned that, under state rules, professional evaluators may also act as service providers, posing a potential conflict of interest. EIPs allow parents to choose a multi-disciplinary team to evaluate the child. Under NYS Health Department guidelines, however, the same person or company providing the evaluation may then provide services such as physical therapy, occupational therapy, or speech therapy, raising the possibility that unnecessary services may be recommended. “This is a statewide issue, and needs a statewide solution,” Mr. Weitzman said.

In another finding, the report noted that the county’s EIP uses a state-provided software system, the Kids Integrated Data System (KIDS), that is antiquated and inadequate. A Health Department staff member described the database as collecting, but not managing, the data. The system is incapable of tracking cases to monitor progress, and does not allow the kind of information retrieval that is now commonplace among database software. Although the state expects to replace the system, the new system is “at least two years down the road,” according to senior EIP staff.

Auditors also were concerned that EIP coordinators are overloaded with cases. During the audit period, the report found that each coordinator was assigned a caseload of 85-94 children, far exceeding the state’s recommended workload of 25-60 children. This has led, predictably, to a backlog of cases; in a sample of cases reviewed, more than half of the family service plans had not been completed within the required 45 days.

The county Health Department reports that, as of January 2005, the average caseload per coordinator has been reduced to 71. “We hope to see continued progress, to bring caseloads into line with state regulations,” Comptroller Weitzman said.

AUDIT SHOWS EARLY INTERVENTION PROGRAM IS “DOING MORE WITH LESS,” COMPTROLLER SAYS

Despite Positive Findings, More Cost/Benefit Analysis is Needed