DISCLAIMER: Raw, unedited transcript from webinar. No guarantees are made for the accuracy of the content.
>> "Please stand by for realtime captions." 
>> We will get started in just a few minutes. 

>> All right. I am showing it is at the top of the hour. This is Robbin Bull  with NCDB . I know some people are still coming into the room. We will get started with the housekeeping items as people are coming into the room. 
>> I want to begin by welcoming everybody. Just a quick note, there is a center pod that has a chat line that you can type your state in. That will help make the word cloud. Rather than in the regular chat pod, if you can type your state in the middle chat at the bottom next to the word send. Then hit send, that will make our fun word cloud of who is here. We just thought we would try that today cut just for fun while people are waiting for the webinar to get started. 
>> And so, phones have been muted. That is to reduce background noise. Pam is finding out at her house. Pam is one of the speakers today and Megan will introduce her. Her neighbor is doing some shooting of a gun. If she is speaking and you hear noises in the background, that is the joys of an online webinar. 
>> All right. I am going to set the recording now. Megan I will let you introduce today's speakers. 
>> [This meeting is now being recorded] 
>> Hello everybody. I would like to welcome everyone to the webinar today. My name is and I am the initiative lead at the national Center on  line this in depth -- death blindness -- death blindness. Joining me today are Emma Nelson and Pam Cummings. We asked them to share today with a solution they created in Vermont to improve their identification and referral efforts. Emma is the project director for the Vermont, the deaf blind project , as well as a director of the Vermont I team early intervention project. She served as an early education, preschoolers with complex needs including deaf blindness . Emma is trained in critical, visual impairment and Emma earned her Masters degree at Hunter College and special education, with a concentration of severe multiple disabilities and Deaf/blindness. 
>> Pam Cummings works for the Vermont early intervention project. All aspects of pediatric care for over 25 years. She has worked in many settings including hospitals, clinics, outpatient and home care. Her primary areas of expertise include infants and toddlers, pediatric orthopedic, positioning and mobility, positioning of equipment and collaborative teaming. Emma and Pam will present their stories about their work over the last few years. We encourage you to put questions you may have for them in the chat pod on the lower right of your screen. We will gather those questions throughout the webinar and hold them until the question and answer session at the end of the presentation. Unless it is a specific question about something they are presenting on at that time. I will interrupt them to insert the question. 
>> This webinar is scheduled to run for 90 minutes but it will end sooner, if all the questions get answered before the time is up. Without further ado it is my pleasure to pass it over to Emma and PM. 
>> Hello everybody, thank you so much Megan. It is such a pleasure to present about this topic. Pam and I have worked together for a number of years. It has been such a joy to work with her. So it was a treat when Megan asked us to do it for us to present together about something we are both passionate about. It's like a celebration, thank you so much Megan. 
>> Today we will talk about the connection between the Deaf/blind project of Vermont . And the outcomes of today's session that we are hoping that you learn how and why our partnership with -- was forged and what the outcome has been as a result of the collaboration. And what steps have been taken to improve outcomes for kids, for infants and toddlers who are Deaf/Blindness , and thinking critically we added some next steps about maybe was as not successful as others as we go forward. 
>> There are not a ton of people on the call. If you have questions we encourage you that you engage in this is a dialogue. It will be easier for us as a way to share additional information, we have a fairly short PowerPoint. If you have additional questions don't hesitate to ask for more information. 
>> When ice first moved to Vermont to work for the project, one of the first things I did was to work with Susan Adelman, a director in Vermont at the time to complete the self-assessment guide for early identification and referral. When I completed it I determined that Vermont really needed to focus on both education and referral for kids that were Deaf/Blindness. As we went through the system , we determine part C was the best section. 
>> This is a screenshot from the actual document, in which we determined that part C was overwhelmingly the best, both in terms of the strength of the relationship, the accessibility of personnel was a big part. As part C had been very receptive to having us be partners and collaborators. They were responding to emails, responding to phone calls. They also, there were resources and relationships that existed, to really make the partnership. I shared an office with one of the assistant directors of part C at the time. We were able to collaborate as we moved forward. Able to have conversations. So part C was clearly the way to begin. 
>> And the strategies, one of the parts that we identified with this in its infancy at the time. There had been project since 1987, a letter I team, interdisciplinary. It worked with children from birth to age 20, to provide technical assistance and training for kids with complex and special education needs. What we have found in the conversation is that the project was funded by the agency of education. We ran into some difficult conversations about supporting age birth to three. At the same time I was working with building and completing self-assessment guide, I also was working with figuring out what we might be able to do with this birth to three population that needed additional training but 
>> So when I completed the self-assessment guide, the immediate need, hope was that through this completion of the guide, we would be able to increase the awareness and knowledge about what the impact is of combined [indiscernible]. We found many people view that is just a multiple disability category. They do not understand the unique needs of kids with Deaf/Blindness  bed and in the long term, the understanding of knowledge would result in increased referrals to the project and identification. 
>> And so, then we began to partner. So the I team, that's what it was called on the slide. And what happened was, as that partnership began to be forged, Pam will talk more about what that looked like, we found as we were getting out and talking, meeting more and more with early intervention teams with kids with all kinds of complex needs, that relationship was allowing us to have a dialogue around kids with Deaf/Blindness . In 2013 and 2014 we had one child identified and referred for the child count. In 2015 we had three, 2016 we had for and 20 17 we had three. According to the self-assessment guide that's right where we should be. I am sure there's probably a few more out there we have not found yet. It has led to the ability for us to find them, those infants and toddlers. 
>> So the I Team early intervention project I spoke about was built  in partnership with [indiscernible]. And with part C is a strong partner from the beginning. As we look at that funding, as I mentioned the I Team has been funded through state appropriation , for education for age 0 to 21. When it was determined that that amount of funding should go to ages 3 to 21, we were trying to figure out how we might be able to find a project for these infants and toddlers. And so part C gave a small grant. And we also worked closely at UVM with the Vermont Child health improvement program. They facilitated something called the Medicaid match which allowed us to draw down dollars and Pam I think you might be able to explain that. To draw down dollars from the same people who work at the center. Since we are not federally funded and to match that Monday to fund -- that money to fund another project. With that information I will turn it to Pam. 
>> That is exactly it Emma. For people not already federally funded, Medicaid will match their program. And for their salary to give us some money. Forgo their salary. That is a variety of people in different amounts of money from a variety of different people. We are really lucky at the center for disability and community inclusion, for having a wizard who really pulled that altogether for us and finds the matching funds for us. It could be different people at the University, different faculty members. Parts of their salary is an example of who might be matched. And we do a little bit of magic, and we feel very lucky we found that funding. 
>> I get to switch the slides? Or can you do it Emma. 
>> Okay. 
>> Thanks. So the I Team early intervention  project, are in interdisciplinary team, there are five of us, seven total. There are five in the team that included Emma, our early childhood special educator. As we said she has a specialty in vision and hearing loss. And there is me, I am a physical therapist. And we have an occupational therapy consultant and a language consultant. She has a special interest and expertise in augmentative and alternative communication. And then we have three family resource consultants. They are regionally across the state. For any team there is five of us depending on where in the state we are. And our goal is to provide technical assistance to up to 20 local early intervention teams. Teams always include families. We support them in delivering services to kids with complex medical and/or developmental needs. And we do it through technical assistance to the specific teams, and we also do training. We are lucky to have the support to do training, very locally. Like to one specific team or all the way up statewide. We are committed to helping with training at the children's integrated services early intervention, that is the statewide intervention. We do a statewide training with them every year. 
>> Other examples of trainings we have done our regional trainings to different areas of the state, that may express a specific need such as we have done a lot of trainings in helping to learn to write out comes that are collaborative. And team-based. We do a lot of the AP training. We are doing a training in the spring on communication with children with autism spectrum disorder. Any other examples Emma? CVI or other vision and hearing loss. We have been lucky to have Emma as part of our team. 
>> I think I just said all of that. There is our beautiful team. Just missing one person. 
>> In our last fiscal year, we had a total of 25 children that we provided technical assistance to their team. Currently we have six aged out. We have a really strong connection with the I team, 3 to 22 part. And five of the six children that turned three did get referrals to the I team. That is a work we have done with teams and families, continuing with the school team. We are happy and proud of that fact and we are also really lucky that several members of our team, of our I-Team early intervention project also  [indiscernible] the I team. So when we transition we get to stay and continue to be with the team. 
>> And five of the children we consulted were Deafblind . 
>> And because I am so lucky again to be working with Emma. When I was first on this team, I did not have a lot of knowledge in Deaf/Blindness. I had a lot of expertise and experience  with children with complex needs, but I have worked with children with deafness, and blindness, but it was not an area I had a lot of exposure to. I was so lucky when I first started to be able to do the modules. And one or two, Emma, all our family resource consultants are doing the modules. I have enjoyed them so much. I offer them up to everyone. I find them so incredibly helpful for children with Deaf/Blindness, but also they serve such , they get such great information for kids with complex needs, whether it's vision and hearing loss or not. I also feel like what I tell other people about these modules, they are done so incredibly well. And although doing all of one module takes a long time. The way they are presented, you can break them up. And the way I have built them into my life is by doing them in 20 to 30 minute chunks, when I have time. I have easily been able to move through it that way. I just think the way the modules are done as a great model for doing online learning like that because you have the module to do on your own and then there is a webinar, live webinar you can participate in, which is a great backup to the individual module. 
>> And Pam, let me add, what she is speaking to with the partnership we developed with the New York project, the Deafblind collaborative in the  Vermont collaborative, working to build certain cohorts around the modules and have worked really hard to get that early intervention practitioners to be involved in them as well. We had sort of a schedule that is set up where we have the module open and then a webinar to process the information . and then we have the next module open and then a webinar to process that information . so that's what Pam is referring to. We have had, about 66 percent of the team, some member of the team or multiple team members can participate in the modules around early intervention providers and the transition team. They have all said pretty universally that it has been helpful to them to both anticipate the students coming into their preschool, and to really understand how to connect with their infant or toddler while they are providing early intervention services. 
>> Go ahead Pam. 
>> It is great when we are working with the team and we know that one of the members of the team has been part of the modules. We are talking about specific technical assistance we might provide. We can say remember, module three when we were talking about hand over hand, this is what we were talking about it and also, extending that to kids that are not Deafblind, to pull some of the things we learned from the module. That's the way we have actually gotten other people to join the modules because they here is talking about it . It is great. 
>> And in our state as many states, would agree, funding for professional development for early intervention providers, is extremely limited. So the idea of participating in free professional development, that provides professional development hours towards continued certification, has been a huge draw for our team. 
>> I think we have the next slide. 
>> Okay. 
>> So we are so happy that we have been able to include the Deafblind kids  and part of our overall services we provided. We signed with both our early intervention project and [indiscernible] the Vermont Deafblind project . Where able to refer to each other so that the kids coming in the door could be one or the other. We have examples this year of both ways that we have learned about kids in both ways. And as our project also have a bunch of different partnerships, with different types, with different teams across the state. We work with a lot of other types of statewide consultants, including the let's see, nine E.. 
>> [indiscernible] 
>> That makes more sense. I am blanking. 
>> The Association for the blind. 
>> Yes. Those are statewide consultants that [indiscernible] as well as our teams connect with. 
>> And with everyone we are working with, we are bringing updates, if we suspect a child might fit the census, we are connecting them with Emma so she can bring information about the census and helping families understand what that means, to be on the census. And the difference between being on the senses and actually getting services from [indiscernible] 
>> I think overall, we have run into a conversation that many states are probably having around how to talk to and solicit, talk to teams in a way that shares information about the project, and then solicit the referral. It is challenging I think at times, because teams say there are so many people on these teams already, we don't necessarily want to add more people. And so what's really been helpful for us is just to increase the visibility of the project, by you guys, I team really talking about us, talking about and using kids who are Deafblind as examples during training. Bringing visibility to what it means, the complexity of what it means to have  vision and hearing loss. Some people see the complexity and start to understand why they may want to refer to the project. That is something we have been struggling with how to talk about the project in a way that makes people want to add team members. So just the more we show our disability, the more we talk about the uniqueness of Deaf/Blindness, the more likely PR  the best people are to recognize what we have to offer it 
>> That is a good point. When we are doing any of our trainings and we pull examples of the types of kids we are working with. Specific kids we are working with. We usually include a child who is Deafblind,  as part of the example of the type of kids we work with. 
>> For example, I don't know Pam if you would like to share a couple of years ago, when you did the collaborative, writing. One child who was not Deafblind but then one that was more complex . When we have parent panels, we will have a parent of a child who is Deafblind, with additional pairings of kids who are not  Deafblind. Were constantly trying to bring in  Deaf/Blindness as a theme  throughout, for the visibility of the disability. 
>> It is funny, because you think, you get on this for us, we got on the strong, forward trend. It felt like we were making such great partnerships, progress. And we are building really good partnerships. You know providing a lot of technical assistance for those meeting our deliverables on an annual basis. And still there is so much work to do. Sometimes it can feel overwhelming and endless. So the next steps for us where to look at the Deafblind project , is to look back at the early identification and referral Sessa assessment guide again. To think about what additional partnerships you might be able to forge. What we realized is that even though referrals to the since have come from the I-Team early intervention project, for people who are visually impaired and for those of the deaf , still not getting referrals from part C personnel. That is a problem. If we are doing this much work with part C, yet based on the ones that call us, it makes me really wonder what message is not clear. Or wonder why, you know it is not viewed as valuable enough to make that referral. I will go back and complete the sales assessment guide again. And hope that it points to other systems that we can potentially look towards. 
>> Another thought that we have had is to work directly with part C, as a funder for the early intervention project. We have a strong relationship with the director of part C. And so talking to her to see if we can implement a protocol, for identification. If they are eligible for vision services, if they're eligible for hearing services, then they must also be referred to our project. Trying to figure out how to work through that, with our part C director, is definitely on the agenda for next steps. In the final part is the utilization of the sooner the better framework. To supplemental trainings. There are so many resources on that framework. That I think could be really valuable to self identify. I remember in the last webinar, the early execution referral initiative, it was chaired how those resources have been used with a couple of the modules for early intervention providers. I am interested in considering that for future work with early intervention providers of Vermont. 
>> So that is it Pam. Do you have anything else to say? 
>> I think that is great. I am wondering if anybody has any questions about the early intervention project. How that works in our state. Or about our partnership with [indiscernible] and Emma. 
>> Pam and Emma thank you. This is Megan speaking. Since it is such a small group, feel free if you would like to hit star and six to unmute your phone. If you have a question for Emma/Pam. Or you can type in the chat pod. Or hit star and six if you want to enter of the discussion if you like. 
>> What this means is you guys were so clear about what you said. [laughter] Any questions? That is okay. 
>> Something I would say I heard you guys mention, while people are thinking if they have a question, is a theme I keep hearing running through all the different Deaf/Blindness projects.  Is a real challenges changeover in staff. Within part C. So they feel like just when they start to get an affiliation with partners, and their understanding increased, about what is Deaf/Blindness, and the state projects. They have to circle back and do that again . And that piece of the work, just keeping the project and the Deafblind concept in front of people, has been very time-consuming. So the question I have for you guys ,  I am assuming this but I will ask it anyway. Do you think the I-Team, because you guys  as an interdisciplinary team, have been able to bridge that awareness? You are hitting them from all angles. Or do you still feel like it is a really big challenge that you have to take on? 
>> One thing that is helpful for us, is part of my role as coordinator is that I help to coordinate the training overall. I have a connection with our statewide early intervention for national development group. So I can listen in and sit in meetings when they are talking about meetings for professional development. And I am also able to contribute from the field, the needs we see. So that is one way we can keep Deaf/Blindness on the  radar statewide. Which is great. But I always knowledge the turnover is a challenge. Keeping awareness there. When we are going, maybe a team we work with several members of, but a newer person is starting and we continue to give our information, even if it's redundant for some people. So everybody keeps hearing it. I think sometimes it's okay to hear it multiple times. It may be just the one kid you are working with at that time that puts you into think now I understand what this is about. And also for new staff, those modules are so gold that they are available and anyone can start with the early ones to get that background knowledge. It is fantastic. 
>> That is helpful. This is Megan still speaking. I imagine that you getting it on those meetings has been extremely helpful. I just keep hearing it from everybody that the turnover is really killing their ability to get those referrals. It is helpful to hear you talk about that. 
>> Does anyone else have questions for Emma or PM? -- Pam. No peer pressure here. [laughter] 
>> I can just say, I will actually read verbatim what was written to me. I thought it might be helpful if any other states are curious about whether their state had a health improvement program like agency, or entity. I can read to you what our director said. She said yes, many states have a V-chip entity. We currently support about 25 pediatric improvement partnerships in the US, who are national improvement partnership network. And they call it the NIPN in project. They all look a little different but they are trying to accomplish the same thing. Some use Medicaid dollars and some don't, as different regions allow different funding streams. There is no easy explanation of Medicaid matched funding, which made me feel relieved that it is hard to explain. It is allowable use Barry so much. -- Varies so much. How she describes it is the state or state entity puts up dollars and Medicaid allows a drawdown or matching of those dollars under certain very specific circumstances. So if your state is interested in exploring this in any way, I think what to look for are national improvement partnerships network projects. (NIPN)
>> I am not aware of anything in another state that is similar to our I-Team early intervention project.  If you are so amazed by what we are doing, and you talk it up with your early intervention folks, if anyone wants to talk to me about how we get started and what we do, I would love to see it moved to other states. Feel free to share my information with your EI partners. 
>> It is such a great entity for partnership cut to partner with with the Deafblind project both  infant toddler and age 3 to 21, they are both training projects. We are able with the Deafblind project to seamlessly go between working within the  I-Team , as sort of a statewide consultant affiliated with the I-Team,  and also single Deafblind projects.  Because of the delivery of services to say it has made partnerships really extremely beneficial. 
>> Awesome. So this is Megan. Does anybody else have any questions for Emma or Pam. You can hit star and six, to unmute, or put it in the chat pod. I will wait another minute. If not, look how easy that was girls. You got done quick. 
>> I know. [laughter] 
>> All right. I will assume the amount of time we have taken is enough. Since there are no further questions, I personally would like to thank everybody again for joining us today . I would also like to thank Emma and Pam for their willingness to share their time and expertise with the Deafblind network. Your innovative approach  serving infants and toddlers, motivating everybody here I am sure to think about how services could be enhanced in their state. I definitely wrote down that organization, to follow up and have a conversation with them. The NIPN acronym . If you leave this webinar and think I have a question now. I am sure Emma and Pam would be happy to hear from you down the road. So thanks again. 
>> We will put this webinar up on the website, under the archives for our webinars . if you want to share it with anybody else, if you're thinking about the service delivery model, to share with other potential partners in your state, feel free to share it broadly. Anyway, thank you again very much everybody for coming. And Robbin Bull  put the link whether webinars can be found in the chat pod. Watch for those and when I put out my April monthly EI forum, I will put the link in there as well, to make it easy for people to find it. Anyway, thanks again to the two of you. Thank you to everybody else who joined. Have a great day. 
>> Thank you Megan. Thanks everybody. 
>> Thank you, goodbye. 
>> [Event concluded]