Data Elements - ECTA Center



New Jersey Early Intervention System

General Supervision Data Review Matrix

|Data Elements |Data Source |Service Coordination Units|Targeted Evaluation |EIP Agencies |Regional Early |Lead Agency |

| | | |Team | |Intervention Collaborative|(DHSS-EIS) |

|New referral information submitted to REIC within 2 |P |SPOE Paperwork |Weekly | | |Paper Review | |

|business days. | | | | | | | |

|Assignment of Service Coordinator |C |SPOE Paperwork | | | |Paper Review |Annual |

| | |SPOE Data | | | | | |

|Primary Referral Sources Report |P |SPOE Data SPOE Report | | | |Six Months |Annual Performance |

| | | | | | | |Report |

|Children Pending IFSP |P |SPOE Data SPOE Report |Weekly | | |Monthly |Quarterly |

|(Referrals in process) | | | | | | | |

|Referrals that exceed 45 days to Initial IFSP Meeting. |C |SPOE Data | | | |Quarterly |Annual |

|Timely delivery of IFSP Services. (30 days) |C |SPOE Data |Paper Review | |Paper Review |Paper Review |Six Months |

|Consent to release information (if applicable). |C |Self-Assessment |Monthly Record Review |Monthly Record Review | |Annual Review |Annual Review |

| | | |Annual Report |Annual Report | | | |

|Family Rights Booklet – documentation in the progress |C |Self-Assessment |Monthly Record Review | |Monthly Record Review |Annual Review |Annual Review |

|note that family was given booklet and information was | | |Annual Report | |Annual Report | | |

|discussed. | | | | | | | |

|Written parental consent for Evaluation/Assessment. |C |Self-Assessment |Monthly Record Review |Monthly Record Review |Monthly Record Review |Annual Review |Annual Review |

| | | |Annual Report |Annual Report |Annual Report | | |

|Documentation that family information meeting was |P |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

|conducted or that the family declined. | | |Annual Report | | | | |

|Family Cost Participation documentation is current. |P |SPOE Data |Monthly Record Review | | |Paper review |Quarterly |

| | |Self-Assessment |Annual Report | | | | |

|IFSPs demonstrate a fit between evaluation summary and |P |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

|IFSP outcomes. | | |Annual Report | | | | |

|Evaluation report contains description and age levels for|C |Self-Assessment |Monthly Record Review |Monthly Record Review |Monthly Record Review |Annual Review |Annual Review |

|all areas of development including cognitive, physical | | |Annual Report |Annual Report |Annual Report | | |

|including vision and hearing, communication, social or | | | | | | | |

|emotional, and adaptive. | | | | | | | |

|Written Prior Notice of the IFSP Meeting |C |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

| | | |Annual Report | | | | |

|Concerns, priorities and resources are reflected in the |P |Self-Assessment |Monthly Record Review |Monthly Record Review |Monthly Record Review |Annual Review |Annual Review |

|outcomes and activities on the IFSP. | | |Annual Report |Annual Report |Annual Report | | |

|Services relate to the outcomes for the child and family.|P |SPOE Paperwork |Monthly Record Review |Monthly Record Review |Monthly Record Review |Paper Review |Annual Review |

| | |Self-Assessment |Annual Report |Annual Report |Annual Report |Annual Review | |

|Individual Child Authorization Report |P |SPOE Data |Review prior to and at | | | |Procedural Safeguards |

| | | |IFSP Meeting | | | |Inquiry |

|IFSP services in natural Environments (Settings) |P |SPOE Data | | | | |Federal Child Count |

| | | | | | | |Annual Performance |

| | | | | | | |Rpt. |

|Justification present on IFSP when service setting is |C |SPOE Paperwork | | | |Paper Review | |

|other than natural environments | |(IFSP service page) | | | | | |

|Lapse of Service By Child Report |P |SPOE Data |Review month in advance | | | | |

|Timely six month IFSP periodic reviews |C |SPOE Data | | | | |Six Months |

|Timely Annual IFSP |C |SPOE Data | | | | |Six Months |

|Children turning Age Three by LEA for DOE |P |SPOE Data | | | | |Quarterly |

| | | | | | | |CMO |

|Transition to Preschool booklet was given and reviewed |P |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

|with the parents within the designated timeframes | | |Annual Report | | | | |

|Documentation of invitation to local school district to |C |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

|participate in a Transition Planning Conference. | | |Annual Report | | | | |

|The IFSP documents individualized plans for transition. |C |Self-Assessment |Monthly Record Review |Monthly Record Review | |Annual Review |Annual Review |

| | | |Annual Report |Annual Report | | | |

|Documentation of attempt to convene a transition planning|C |Self-Assessment |Monthly Record Review | | |Annual Review |Annual Review |

|conference for children that are not transitioning to | | |Annual Report | | | | |

|Part B to discuss appropriate services. | | | | | | | |

|Transition Planning Conference conducted at least 90 days|C |SPOE Data | | | | |Annual |

|prior to age three. | | | | | | | |

|Exit Reasons |P |SPOE Paperwork | | | |Paper Review |Federal Annual Child |

| | |SPOE Data | | | | |Count |

|Formal Dispute Resolution Report |P |Procedural Safeguards | | | | |Quarterly |

| | |Database | | | | | |

|Informal Procedural Safeguards Report |P |Procedural Safeguards | | | | |Quarterly |

| | |Database | | | | | |

| | | | | | | | |

|% Birth to 1 year old w/ an IFSP |P |SPOE Data | | | |Child Find Follow-up |Annual Performance |

| | |Census Data | | | | |Report |

|% Birth to 3 years w/ an IFSP |P |SPOE Data | | | |Child Find Follow-up |Annual Performance |

| | |Census Data | | | | |Report |

|Average age at Referral |P |SPOE Data | | | | |Annual Performance |

| | | | | | | |Report |

|Primary Languages |P |SPOE Data | | | | |Six Months |

|CONTRACT COMPLIANCE |

|Service Coordination Caseloads |CC |SPOE Data |Annual & ongoing update | | |Ongoing Data Entry and |Annual Contract |

| | |Grant Contract |reporting | | |Cleaning |Renewal |

| | |Personnel | | | | |Ongoing Notification |

| | |Consultation Notification | | | | |Review |

| | |Form | | | | | |

|EIP agencies comply with minimum FTE requirements and |CC |LOA Initial Practitioner |Monthly | |Ongoing Service Matrix | |Annually |

|Practitioners. | |Enrollment | | |Updates | | |

| | |Service Matrix | | | | | |

| | |EIP Assignment E-mail | | | | | |

| | |Lists | | | | | |

|Agency complies with practitioner requirements for a mix |CC |Practitioner Enrollment & | |Ongoing |Ongoing | |Initial Enrollment |

|of specialties. | |Terminations | | | | |Annually |

| | |Service Matrix | | | | | |

|Expenditure reports are submitted timely and accurately. |CC |Expenditure Reports |Quarterly | | |Quarterly |Quarterly |

| | |Contract & Fiscal Unit | | | | | |

| | |Tracking | | | | | |

|Funds From Other Sources Survey |CC |Grant Contract |Annually |Annually |Annually |Annually |Annually |

| | |Expenditure Reports | | | | | |

| | |FOS Survey | | | | | |

|Comprehensive EIP serves as individual child’s EIP Home. |CC |SPOE Report | | |Ongoing | |Annually |

| | |EIP Home | | | | | |

|Change of agency information provided timely. |CC |NJEIS Database Directory |Ongoing & at least |Ongoing |Ongoing |Ongoing |Ongoing |

| | |Report |annually | | | | |

|Self-assessment submitted timely and completely. |CC |Tracking Report | | | |Annually |Annually |

|Service Coordination Service Encounter Verification Logs |CC |CMO Trend Reporting |Monthly | | | |Quarterly |

|are submitted timely and accurately to the CMO for | |SPOE Report | | | | | |

|Medicaid Billing. | | | | | | | |

|CSPD CONTRACT COMPLIANCE |

|Practitioner Credentials |CC |Covansys | | | | |Initial Practitioner |

| | |EIP Agency | | | | |Enrollment |

|Agency Training Requirements |CC |CSPD Database | | | | |Initial |

|Practitioner Training Requirements |CC |CSPD Database | | | | |Ongoing |

|Procedural Safeguards |

|Procedural Safeguards Reports | |Informal | | | | |Quarterly |

| | |Formal | | | | | |

| | |SICC | | | | | |

|Incident Reports | | | | | | | |

|Mediations/Hearings | | | | | | | |

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