One of Vermont’s most innovative programs in early childhood is Children’s Integrated Services (CIS). Families with young children have been able to access multiple supports through one entry point for over 10 years because policymakers understood that this approach would improve child outcomes and be a more efficient, effective way to deploy our financial and human resources.
However, the Scott administration, as well as members of the Vermont Legislature are looking at dismantling this program.
CIS becomes available to families once they are pregnant, offering access to home visiting through nursing and family support. Staff can help families identify and implement their goals which might include anything from eating better to finding new housing. Once a child is born the supports continue seamlessly. If there are challenges with breastfeeding a nurse will help. If a child is born with a developmental delay an early interventionist is available. If paying for child care is a challenge a family support worker can connect a family with child care financial assistance. If a child has a special health need specialized child care resources are available. All the people providing these supports work together on one team in CIS. The family does not need to keep track of multiple phone numbers and agencies. They have one intake and do not need to fill out endless forms answering the same questions repeatedly. They have a coordinated plan which documents their current goals and informs the team what they are working on. This is true even when members of the team are employed by different agencies. Additionally, the CIS team works closely with other providers in the community: obstetricians, pediatricians, child care programs, social service providers, and state offices, to help families get the resources they need. Imagine the time and effort that is saved with this coordination. Removing barriers means easier access, ultimately leading to better child development during the years when it matters most for future success.
CIS is an excellent example of how the whole is greater than the sum of its parts. A nurse who is doing a home visit to help a new baby with breastfeeding might get questions about why the 2-year-old in the house isn’t talking much. The nurse could suggest calling the pediatrician, which the parent may or may not do given the hectic nature of life. In CIS the nurse could suggest bringing a colleague on the next visit who works in early intervention and can help assess if there is a speech delay. If there is a delay, the early interventionist would connect with the pediatrician to get background information, share the assessment and keep them informed about the plan, which might include services from a speech and language pathologist if needed. This holistic team approach helps ensure the child will get what they need and not fall through the cracks because a phone number was lost, a form was not filled out, or an appointment missed.
This coordination can happen in part because the payment mechanism makes it easy. CIS is a managed care model that demonstrates why flexible, braided funding in a “bundle” works better than fee-for-service. The nurse and the early interventionist do not need to figure out who is billing and whether they will get paid, they just need to document the service. The fiscal agent in each community can then bill to draw down the CIS bundle based on a case rate and up to a cap. In this way, the services are responsive to the needs of families in the community and not based on a certain amount of money being available for a specific service. If we need more nursing, we provide more nursing, and we can keep the other services as well.
CIS operationalizes collaboration and saves money in both the short and long term. In the short term, there are efficiencies in paperwork and the time spent doing it because there is one intake and one plan. This single point of access also saves time since families and children do not have to go to multiple places to get services. This increases the likelihood that families will actually get the services they need to successfully support their child’s development, leading to the long-term pay-off. Children who get a strong start in the first 5 years of life are more likely to be successful in school and are healthier as adults.
Having both better human and financial outcomes is the power of integrated services, and Vermont is leading the way in early childhood with CIS. Learn more about CIS at dcf.vermont.gov/child-development/cis. Please contact Governor Scott and tell him to make sure CIS has the support and leadership it needs to do its job well.