Most children receive First Steps services at home. Trained teachers and therapists work with both the parents and child on activities tailored to address the child’s specific delay or disability. The plan to help the child – the Individualized Family Service Plan (IFSP) – is developed by a service coordinator in cooperation with the family. An early intervention team is then assembled to carry out the IFSP. A child having trouble pronouncing words might get help from a speech pathologist, while a child with movement delays might be assisted by a physical therapist.
For medical conditions like Down syndrome, or other serious disabilities, the need for intervention will be obvious at birth, but for many other delays it might be several months before the parents or someone else realizes that help is needed. The Missouri Department of Elementary and Secondary Education (DESE), which is the state administrator of First Steps, has established 10 regional points of entry that arrange for an initial assessment of children. Parents can call 1-866-583-2392 toll-free to request an initial assessment of their child.
Children diagnosed with a qualifying disability, delay or medical condition are then eligible for services, which are provided under contract from a variety of agencies located around the state. In order to ensure services are of a high quality, teachers and therapists must meet specified state qualifications and DESE monitors the services provided.
The most recent review of First Steps by DESE concluded that about 70% of the children participating in First Steps improved their social and knowledge skills and acted more appropriately than they would have without intervention. However, early intervention is not a magic wand. Although milder delays and disabilities can often be addressed so that by the time the child enters kindergarten they are on par with their peers, more serious disabilities and medical conditions may require special education throughout the school years. and assistance later as adults through sheltered workshops or other programs.
Under Part C of the Individual with Disabilities Education Act (IDEA), states have some discretion in determining which children will be eligible for early intervention services. Some disabilities are severe enough, such as Down syndrome, cerebral palsy, or being blind or deaf, that eligibility is never in doubt. However, most children have less serious disabilities and in these instances the state of Missouri requires at least a 50% delay before a child will be deemed eligible. Families with children with milder delays who do not qualify for First Steps may be able to get help through the Parents as Teachers program, which will be discussed in a future update.
Spending on First Steps has been stagnant in recent years. In fiscal year 2010 Missouri spent $25.7 million on direct services for children; by fiscal year 2014 that figure had increased by less than one million, coming in at $26.6 million. This level of expenditure may provide adequate services for the children presently served, but if Missouri wanted to expand eligibility to include children with milder delays, more funding would be needed. Unlike some other states that declare children eligible but then do not serve them, Missouri has been cautious in not promising what it cannot deliver.