Interagency Self-Assessment Form

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Interagency Self-Assessment Form

Early Childhood Transition Self-Assessment



    This document was a collaborative effort, developed by:

    Ann Bailey, NCRRC; Ron Dughman, MPRRC; Grace Kelley, SERRC; Karen Mikkelsen, NERRC; and Michael Sharpe, NCRRC.

     This document was developed for the Early Childhood Transition Priority Team, which is part of the Regional Resource Center Program. A special thank you goes to the other priority team resource members who provided valuable feedback to the developers.

    The paper, “Designing and Implementing Effective Transition Processes” can be found at

    More information on early childhood special education transition can be found on the National Early Childhood Transition Initiative website

    Early Childhood Transition Self-Assessment Form

    A Self-Assessment Process designed to accompany the paper “Designing and Implementing Effective Early Childhood Transition Processes.”


    The Early Childhood Transition Self-Assessment Form was developed from information provided in “Designing and

    Implementing Effective Transition Processes” (National Early Childhood Transition Initiative (NECTI), 2008), hereafter referred to as the “Process Document.” The Early Childhood Transition Self-Assessment Form is intended

    to provide a means of formative evaluation for interagency staff and administrators, at the state, regional, and/or local level using the content of the Process Document. As described by Worthen, Sanders, & Fitzpatrick (1997), “formative evaluation is conducted to provide program staff evaluative information useful in improving the

    program” (p. 14). As such, formative evaluation is a reflective process that can help interagency staff develop insights about the effective implementation of the service delivery system, along with those aspects that need improvement.

This Self-Assessment Form is not a stand-alone document because the content and standard for judging the state’s

    performance is based on the Process Document The Process Document should continue to be a reference point for your work. However, the Self-Assessment Form gives you an opportunity to use that content in evaluating the relative strengths and opportunities for change in the transition process. The Self-Assessment Form may be used to:

    1) provide staff with a pathway to those sections of the document that may be most helpful in

    determining how to address improvement of the early childhood transition process;

    2) serve as guide for early childhood transition system discussions at State, regional, and local

    levels; and

    3) provide information on specific resources related to identified strengths and challenges. Design

    The Early Childhood Transition Self-Assessment Form includes the following key interest areas: A. Interagency Policies and Practices, B. Personnel Development and Training, C. Roles and Responsibilities, and D. Strategies and Practices. Each area contains eight “components,” addressed in the Process Document (NECTI, 2008). The components include:

    I. Content and Scope V. Policy Alignment and Congruence

    II. Interagency Structure VI. Personnel Development, Staff Training, and Resources

    III. Interagency Communication and Relationships VII. Data Systems and Processes

    IV. Interagency Agreements VIII. Monitoring and Evaluation

    The component numerals and the element letters within the Self-Assessment Form correspond directly to the way in which they are displayed in the Process Document. For instance, key interest area “A. (Interagency Policies and Practices), Component V (Policy Alignment and Congruence) includes two elements: A. Transition requirements and timelines are aligned across agencies, and D. Mechanisms to minimize disruption in services before, during, and after transitions are developed. These elements correspond directly to pages 24 and 26 of the Process Document. Each component in the Process Document is further defined by evidence statements. These statements can represent legal requirements or policies and practices considered to reflect contemporary interagency services and programs,

    either through research or agreement within the professional community. Evidence statements are not necessarily considered to be exemplary practicerather, they are standards to be used to guide interagency staff and

    administrators in efforts leading to improvement, both within and between agency services and programs. The evidence statements provided in this self-assessment, as they are in the Process Document, are in no way exhaustive. Any number of evidence statements could be developed by state and/or local staff to address the State’s early

    childhood transition system.

    The Process Document contains multiple evidence statements for each component. In the Self-Assessment Form the sample evidence statements have been simplified organized into key elements related to four areas that address program function:

    A. Interagency Policies and Practices;

    B. Personnel Development and Training;

    C. Roles and Responsibilities; and

    D. Strategies and Practices

    These four areas have been designed to highlight key elements which may help to direct the user to critical factors related to program improvement.


    The Early Childhood Transition Self-Assessment Form was designed to be used by a team of transition stakeholders. The completion of the self-assessment can be done in two ways. First, individuals can complete the form independently and bring it to the group to discuss common and varying perspectives. A consensus process may be used to summarize the ratings. A second method is to use only one form for the entire group, using a consensus approach throughout the process. Either method will produce useful results.

    To complete the form, each component and related evidence statements are rated as: (1) Functioning Effectively, (2)

    Needs Improvement, or (3) Not Yet Established. While making a judgment may be challenging at times, remember

    that each option is entirely qualitative and basically serves as a point for group discussion. It is important to note that some components contain evidence statements that require making a judgment applicable across the spectrum of

    interagency programs (AP), while others are only applicable within a program (WP). These are referred to as a

    “Response Type” and should be considered throughout the completion of the Early Childhood Transition Self-

    Assessment Form. Also, note that some components will not apply in every major area. These cases are identified by the term “No Related Elements.”

    Groups may choose to complete any or all of the four key interest areas, based on needs of the transition system. Because groups may choose to complete any or all interest areas, evidence statements have been repeated to demonstrate the importance of specific issues within each interest area.


    By totaling the number in each response category for a given area, a determination can be made regarding the potential strengths and opportunities for change in that area. A higher score in either the “needs assistance” or “not yet established” category would signify a need for closer analyses of those parts of the transition process. A more in-

    depth look at those components in an area can yield information on strengths and challenges within a particular component and resources that could be utilized for improvement. By cross-referencing the self-assessment with

“Designing and Implementing Effective Early Childhood Transition Processes,” additional strategies and resources

can be identified to address the needs uncovered through this process.

Interagency Self-Assessment Form

    A. Interagency Policies and Practices

    Component Evidence Statement Response Type

    I. Content and Scope

    A. Families have access to a broad array of ; Interagency agreements (IA) / memorandum of AP Functioning child developmental and educational understanding (MOU) are up to date and include Effectively services, supports, and/or settings to meet information about the specific linkages, resources Needs individual child and family needs. and coordination efforts between and across Improvement services and supports for both children and

    families (i.e., both idea and other state level Not Yet programs such as a home visiting program for at-Established

    risk populations).

    B. Families have access to a broad array of ; A centralized information/referral system is in AP health and medical services to promote place and used that includes a wide range of

    overall well-being in order to meet resources related to child health, well-being and

    individual child and family needs. overall development (e.g., 1-800 number or web


II. Interagency Structure

    A. An interagency entity (or entities) exists and ; The interagency group coordinates with the AP has membership with the authority to leadership in each respective agency.

    influence agencies’ transition policies and


    B. A shared philosophy serves as a foundation ; The vision and philosophy address child and AP/WP for transition policies, procedures and the family outcomes related to their preparation for determination of responsibilities and actions and adjustment to transition.

    ; Policies and procedures are clearly stated and AP/WP reflect compliance with federal and state

    regulations and requirements. See 34 CFR

    ?303.14 8

    ; Policies and procedures clearly delineate AP/WP program- specific responsibilities as compared to

    interagency responsibilities.

III. Interagency Communication and Relationships

    A. Effective and ongoing mechanisms for ; A shared vision and principles form the basis of AP communication between and across agencies communication, problem solving and decision and programs are developed. making.

     A. Interagency Policies and Practices 6

Interagency Self-Assessment Form

    ; Agency and interagency meetings are held to AP accomplish specific purposes, are attended by the

    most appropriate stakeholders, and result in decisions

    and mutually agreed upon actions.

    IV. Interagency Agreements

    A. The interagency agreement provides clear ; A clear statement of values and philosophy to guide AP statements of transition processes in and support effective transitions for children and compliance with federal and state families is included.


    B. Agency roles and responsibilities related to ; Interagency agreements delineate steps of transition AP transition are clearly assigned. process and responsibilities of sending/receiving


    ; An interagency dispute resolution process is AP described with clear specification of re-negotiation procedures.

    C. Critical policies are specified in the ; Fiscal and other resource responsibilities are AP interagency agreement. delineated in detailed, easily understood, and

    accessible language.

    ; Accountability for the allocation and expenditure of AP resources is specified in the interagency agreement (34 CFR ?303.523(b)).

    D. Format, content, and level of specificity of ; State-level format is adaptable for locals to use, AP state-level agreements serve as a model for including a sample/example.

    local agreements.

    ; State-level interagency agreements provide written AP guidance for more specific local procedures.

    ; Required components of a local interagency AP agreement are specified by the state agencies.

    ; Local agreements are up-to-date and are implemented AP as written.

    E. Interagency agreements are routinely ; Interagency agreements are regularly reviewed to AP reviewed and revised based on data and assess their functionality and effectiveness and are

    input from stakeholders. updated as needed.

    ; Interagency agreements are updated to reflect AP changes in federal and state law.

     A. Interagency Policies and Practices 7

    Interagency Self-Assessment Form

    ; Evaluation of effectiveness includes feedback from AP families.

; Interagency agreements should be on agenda of SICC AP and SAC at least annually.

; Interagency agreements are used at major agency AP planning events.

    ; State agencies monitor local interagency agreements AP and how well they are being implemented (if they exist in the state).

; Local interagency agreements are updated to reflect AP changes in federal and state law.

; Agencies have mechanisms for input into the WP functioning of the interagency agreement.

    ; Feedback and input from state and local staff WP regarding interagency agreement implementation are considered by the lead agency in the review process.

     A. Interagency Policies and Practices 8

Interagency Self-Assessment Form

V. Policy Alignment and Continuity

    A. Transition requirements and timelines are ; Interagency agreements address any misalignment AP aligned across agencies. or incongruity between regulations, policies and

    practices among participating agencies, e.g.,

    timelines, continuity of services during summer,

    funding gaps, and other special circumstances

    around a child’s 3rd birthday.

    ; A transition manual that explains requirements and AP timelines is developed by all agencies and

    provided to parents.

    ; Agencies jointly plan and implement LEA AP notification requirements.

    D. Mechanisms to minimize disruption in Agencies consider funding overlap services during the AP services before, during, and after transitions 6 months prior to child’s third birthday.

    are developed

    VI. Personnel Development, Staff Training, and Resources

    A. Designated personnel or entities at state, ; Contracts and interagency agreements include AP regional and local levels share responsibility agency roles and coordination responsibilities for for interagency training and technical personnel development activities.


    B. Personnel development activities are jointly ; An interagency advisory group, including AP designed, implemented, and evaluated by representation by stakeholders such as family agencies and programs involved. members and parent organizations informs

    personnel development design, implementation

    and evaluation.

     A. Interagency Policies and Practices 9

Interagency Self-Assessment Form

VII. Data Systems and Processes

    C. Protocols and procedures for data sharing ; Mechanisms are in place to share data across Parts AP across agencies are clearly defined C (Lead Agency) and B (SEA) (e.g., common

    identifier, data sharing protocol, common

    transition tracking form from referral and

    eligibility determination).

    ; Data sharing agreement (e.g., memorandum of AP understanding) addresses procedures related to

    sharing of data, confidentiality, notification, etc.)

    ; Guidance is publicly available that describes what AP data can be shared across Part C and Part B and the

    circumstances when data cannot be shared (e.g.,

    Part B cannot share Part C data with other


    E. Data collected through monitoring regarding ; Transition data is analyzed across agencies and AP transition are analyzed and used for decision-with parent involvement.

    making within and across programs.

     A. Interagency Policies and Practices 10

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