Anecdotal information has recently suggested that families of infants and toddlers with disabilities in Nebraska were seeking early intervention services from providers not affiliated with the free, state-sanctioned "Early Development Network" and children's "Individualized Family Service Plans" (IFSPs). The purpose of this evaluation study was to document the extent and reasons for such practices across the state. In particular, the incidence of duplicated services were examined for physical, occupational or speech therapy provided by public school employees and reimbursed by the state "Medicaid in the Public Schools" program (MIPS) and also Medicaid providers in the community clinics and hospitals. The evaluation study analyzed data from a four primary sources and populations, including (a) families of infants and toddlers with disabilities who received early intervention services in 2004 (n = 121), (b) state-employed Service Coordinators for the "Early Development Network" across the state (n = 49), (c) experts in Nebraska's early intervention services (n = 6), and (d) the data for infants and toddlers in Nebraska who were on record with the state as referred to the "Early Development Network" and the services they received in 2004 (n = 3,939). Results suggest that a small percentage of children in 2004 received early intervention services from outside the "Early Development Network" and documented IFSP. Less than half of the families surveyed reported use of non public school providers for PT, OT or SP; less than 10% of the state-wide data showed Medicaid billing from nonschool Medicaid providers for these services. Although as many as 50% of the families surveyed reported use of both school and nonschool services in 2004, less than 3% of all Medicaid-eligible children that year showed billing through both MIPS (schools) and community Medicaid Providers for PT, OT and SP services. Exclusive use of nonschool providers for PT, OT or SP services was reported by less than 7% of the families, and less than 10% of the Medicaid-eligible children in the state database. The majority of exclusive, non-school services reported by families were related to audiology and vision needs followed by psychology, occupational therapy, speech therapy and then physical therapy; payment for these services was most often private insurance. Families and Service Coordinators delineated two primary reasons why families sought nonschool services for their children: (1) a desire for more or different services than those provided by the school-based IFSP team and (2) physician recommendations. Implications are suggested for state understanding of families' use of individual or duplicate services and the need to have early intervention teams coordinate and collaborate to reduce duplication of efforts when possible. Appended to the report are: (A) Nebraska Early Development Network--Healthcare Coverage Services Coordinators' Survey; (B) Nebraska Education Development Network--Healthcare Coverage Family Survey; (C) Common Themes from Expert Stakeholders Answers to Interview Questions; (D) Service Coordinators' responses to the question: What Challenges or advantages do you face when families seek to complement or substitute EDN/IFSP-sponsored services with PT, OT or Speech Services from other providers? and (E) Open Ended Responses to Family Survey.