Grants to states for early intervention services  and special education and related services for children with disabilities  and their families are provided mainly through Parts C and B of the act. Part C requires that every state make certain services  available, including special therapies such as physical, occupational, or  speech language therapy, and family supports such as home visits. States Have Different Eligibility Criteria and Means of Assessing Developmental Delay

Nationwide, states’ eligibility criteria for Part C services vary, with most  states specifying the amount of delay in development a child must  experience to be eligible for services, while a few rely exclusively on the  judgment of a multidisciplinary clinical team. In 2004 the percentage of children  served from state to state ranged between 1.3 and 7.1 percent. Through this program, they receive services  similar to those children receive under Part C.

		Majority of Children Served under Part C Are between Ages 2 and 3

While Part C funding is intended to serve infants and toddlers from birth to  age 3, the majority of children receiving services are toddlers between  ages 2 and 3. For example, in one of the sites we visited, posters were developed to  hang in doctors’ offices across the state to help inform parents about Part  C.
Despite their public awareness campaigns, the states we visited reported  having difficulty reaching all eligible children. To fund early intervention services for children from  birth to age 3, states relied on funding from multiple sources, including  federal, state, and private funding. States Provided a Broad Array of Services to Infants and Toddlers, but States We Visited Reported Challenges Recruiting and Retaining Staff

As required under Part C, states provide a broad array of early intervention  services to infants and toddlers. All 50 states reported using state general  funds. Both OSEP and States Use Data to Monitor Part C Compliance, but Challenges Persist in Transitioning Children to Part B

OSEP monitors the states, which in turn oversee local Part C programs by  examining data on how well programs identify, serve, and transition  children to other programs when they are too old for Part C. In its  oversight, OSEP tracks data on program performance submitted by states  through annual performance reports and other mechanisms. OSEP found Nevada  (which was the state that served the lowest percentage of infants and  toddlers at 0.9 percent in 2003) out of compliance for not ensuring that all  children who may be eligible for early intervention services are identified,  located, referred, and evaluated in accordance with Part C. Hawaii, which  serves the largest percentage of children, including children at risk of  having a substantial developmental delay, was found out of compliance  because it lacked procedures to ensure evaluations and assessments were  conducted in all the areas required by Part C.
When states are not in compliance with Part C and do not show  improvement in their performance, even after receiving technical  assistance, OSEP has several options. Education noted that preliminary and  unpublished data from a department study indicate that gaps occur when  children are transitioned from Part C to Part B, not only during the  summer, but whenever transitions occur. If Part B eligibility is not  determined prior to children turning 3 during the summer months, then  related decisions, including those about extended school year services,  cannot be made. IDEA Part B, administered by the Department of Education, provides  grants to states to provide preschool services to children with disabilities  from age 3 to 5.
Why GAO Did This Study

Part C of the Individuals with Disabilities Education Act (IDEA) was established to ensure that infants and toddlers with disabilities, from birth to age 3, and their families receive appropriate early intervention services. Within the Department of Education (Education), the Office of Special Education Programs (OSEP) is responsible for awarding and monitoring grants to states for Part C according to IDEA requirements. To address questions about how states have implemented IDEA Part C, this report provides information on (1) how Part C programs differ in their eligibility criteria and whom they serve, (2) to what extent states differ in their provision of services and funding, and (3) how Education and state lead agencies help support and oversee efforts to implement Part C, such as identifying children for services and transitioning children to follow-on programs, such as IDEA Part B.

What GAO Found

Eligibility criteria for Part C services for infants and toddlers with disabilities differ from state to state, but do not consistently explain the percentage of children served, which ranges between 1.3 and 7.1 percent. To determine eligibility, most states measure how much the child is delayed in one or more areas of early childhood development, while a few rely exclusively on a clinical team's judgment. Although IDEA Part C is intended to cover children from birth to age 3, most states provide the majority of their Part C services to children 2 to 3 years old. States have public awareness campaigns to identify more eligible infants and toddlers but cite a number of obstacles, including difficulty reaching children in rural areas or in families where English is a second language. The states we visited provide a similar set of services but vary in funding sources. States are required to make available certain early intervention services under IDEA, such as occupational, physical, and speech therapy. However, states report challenges recruiting and retaining professionals, such as speech language pathologists, to provide these services. States rely on various funding sources, but state general revenue funds were generally the largest source of early intervention funding. OSEP and state lead agencies have provided training and technical assistance and used data to monitor implementation of IDEA Part C, but OSEP has lacked some information from local officials needed to determine if children are smoothly transitioning from Part C to Part B. OSEP uses annual reports and performance indicators as part of its effort to monitor compliance with Part C and target technical assistance. For example, data on the percentage of children served help inform OSEP of states' efforts to identify all eligible children. States use similar approaches. Despite these activities, state officials cited challenges transitioning children to Part B services when they turn 3 years old. Education indicated that in preliminary and unpublished data from an ongoing study it had found that gaps occur throughout the year. Officials in the states we visited reported that some children who turn 3 during the summer experience gaps in service. If Part B eligibility is not determined prior to children turning 3 during the summer, then subsequent decisions about whether children should receive extended school year services cannot be made.