Eighteen-month-old Ryann Harmon went from balancing on a big red exercise ball to pulling strings of beads from physical therapist Jim Cooley's ears. It's all part of the workout.
Cooley has visited the Harmon home weekly since July 2010 to do therapy with Ryann and her triplet sisters, Reese and Regan. The sisters were born 10 weeks premature -- on April 23, 2010 -- to parents Tami and Adam Harmon of Lafayette. Each of the girls has had to work with Cooley on different developmental delays, but Ryann's spina bifida (an incomplete closure of the spine over her spinal cord) has left her with weakness in her left leg and more areas to play catch-up.
"We attribute it to the Lord and to Jim, but she's been doing so great," Tami Harmon said.
After not knowing at the beginning if Ryann would ever be able to crawl or walk, the Harmons celebrate the fact that she's making progress every day toward that mobility.
The family is an example of happy clients of First Steps, a state-run early intervention program for children younger than age 3 with developmental disabilities. Indiana officials last year started looking at ways to add oversight of the program while cutting costs, and a series of changes rolled out this year. The Harmons didn't see any interruption in services or changes in cost, but some families and providers were more impacted by the new state requirements.
The income-based fee scale for First Steps services still doesn't charge families earning less than 250 percent of the federal poverty level -- which amounts to just over $56,000 for a family of four. But the fee scale for those earning more charges families per 15 minute-increments of services with monthly maximum payments ranging from $48 to $1,600. Additionally, the families' private insurance companies are being billed for the sessions.
The changes made to the administration of First Steps caused some unrest among providers and confusion among families served, but the results have been positive overall, said Dee Ann Rowley, program director for this region.
Therapy providers used to be allowed to operate independently through the program, but the state made changes a year ago that require them to have agency affiliation and oversight. Pediatric Physical Therapy Services Inc. is the local agency provider currently for the nine-county region.
Jamie Stormont-Smith, head of Pediatric Physical Therapy Services, said it was a major adjustment for many providers working with area families to come under her agency's umbrella. She's grateful to be working with them and said most providers seem to be settling into the new arrangements.
Delay noticed
Jim Cooley, the Harmon's therapist, was already working for Pediatric Physical Therapy Services before the state made changes to the program, so he's not been impacted as much as some others. He knows at least one other therapist who was doing part-time work for First Steps and decided to stop instead of going through all of the new requirements outlined by the state.
With cost-saving measures being added, Cooley was concerned that requests made for additional therapies might start getting denied by administrators.
"But there's not been a request that I've made that's not been OK'd yet," he said.
Emily McKinley, whose son, Sage, started using First Steps services in January and noticed an initial delay in finding a speech therapist. The West Lafayette mother of two attributed that to the bottleneck as providers tried to meet new state requirements for eligibility, but said she's not had any other issues from the First Steps changes.
"We're extremely grateful for the services we've received," McKinley said.
More than half of the children served through First Steps, at least in the local nine-county cluster, received speech therapy and/or developmental therapy in the past year. The developmental therapy includes cognitive, physical, communication, social and adaptive work.
Many of the toddlers getting services, roughly 43 percent in each category, received occupational or physical therapy. These exercises focused more on motor skills, including movement of legs and arms along with self-help skills such as feeding.
The state data from April 1, 2010, to March 31, 2011, shows that 1,237 children worked with First Steps providers in the service area including Tippecanoe and eight surrounding counties.
One of the best changes Rowley has noted from the recent program overhaul is that First Steps has an easier time sending therapists to outlying counties.
"In the past we had a hard time getting independent people to go to the more rural areas," Rowley said. "Now we have a little more leverage, and that's been a really positive thing for us and for the families there."
First Steps therapists aim to work with children in their natural environments, usually their homes or day care centers, and occasionally complete sessions out in the community.
"If the family says they need help taking the child to the grocery store, or maybe the child can't ride in the car without screaming, our providers can go with them," Rowley said. "These are services families really need."
(Source: jconline.com)
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