This document discusses building effective developmental screening services that meet the needs of programs, staff, and families. It emphasizes the importance of using data from developmental screenings to accurately identify children at risk for delays and connect them to early intervention services. The data shows that staff were under-identifying children as at-risk and had low rates of connecting identified children to services. Barriers like policies, communication, and staff confidence need to be addressed. Input from stakeholders is important to understand challenges and improve screening quality, staff competency, and family support.

1. Building Effective Screening Services Understanding the Needs of Programs, Staff, & Families A Brighter Tomorrow Symposium July 19-21, 2011 Janell Smith-Jones, Ph.D. Andrea Rudek, M.S.W. Milena Nigam, M.S., M.A.T. The Office of Child Development University of Pittsburgh

2. Our Community Partner Community-based providers In-home and center-based services Predominantly serves single, minority, and low-income parents Parenting education and child development (Birth – 5 years)

3. Why Screen? Signs of delay and behavioral issues can be overlooked or dismissed Screenings help better identify developmental and behavioral concerns and determine when further evaluation is needed

4. Early intervention (EI) services support children’s healthy development and help them reach their potential.

5. Nationally 12 % Developmental delays or behavioral concerns (Cooper, Mast, and Vick, 2009) 2.4 % Receive EI services (Hebbeler, et. Al., 2007)

6. But, screenings are ONLY impactful if… Administered correctly Accurately identify children at risk for delays Lead parents and professionals to take concrete “next steps”

7. Quality Screening Services FOLLOW- THROUGH COMPLETION IDENTIFICATION

8. How Well Are Staff Identifying Children At Risk Through Screenings? Identification Rate (% at risk among those screened) Appropriate Benchmarks (comparable population)

9. Identification Rate Developmental Skills Children Correctly Screened (ASQ) 11% Identified as At Risk

11. Does 11% represent missed children?Benchmarks provide standards for comparing how well we’ve identified our population of children

12. Benchmarks Developmental Skills Children Correctly Screened (ASQ) 22% of the children should have been identified as at-risk for developmental delays conservative estimate based on multiple national samples 11% identified as at-risk

13. Benchmarks Social-Emotional Skills 18% of the children should have been identified as at-risk for social-emotional concerns conservative estimate based on Ages and Stages manual Children Correctly Screened (ASQ: SE) 8% identified as at-risk

14. How Well Are Staff Identifying Children At Risk Through The Screenings? Identification Rate + Benchmarks demonstrated that children are being significantly under-identified as at-risk across the network

15. How well are staff connecting children identified as at risk to EI services? Locally Children evaluated by EI Children identified as at-risk by screenings 13 258

16. What happened?

17. What data should programs collect? Children whose parents agreed to recommendation Children admitted for EI services Children identified as at-risk by screenings Children evaluation Children recommended for further evaluation Children referred for further evaluation Children qualified for EI services

18. How well are staff connecting at risk children to EI services? Children admitted for services Children whose parents agreed to referral Children identified as at-risk by screenings Children evaluated Children recommended for further evaluation Children referred for further evaluation Children qualified for services 8 13 10 47 57 90 2 2 21 258 1 9 13 31 1 55 2 113 No Data Missing in MIS

19. How well did staff connect at risk children to EI services? Children admitted for services Children whose parents agreed to referral Children evaluated Children identified as at-risk by screenings Children recommended for further evaluation Children referred for further assessment Children qualified for services 8 13 10 47 57 90 258 5% 3%

20. Detailed documentation of the service delivery process can reveal areas where quality improvement efforts are needed by showing the breakdowns in connecting children to EI services. What might the breakdowns suggest?

21. Policy, Supervision, Communication & Confidence Children admitted for services Children whose parents agreed to referral Children identified as at-risk by screenings Children evaluated Children recommended for further referral Children referred for further assessment Children qualified for services 8 13 10 47 57 90 2 2 21 258 1 9 13 31 1 55 2 113 No Data Missing in MIS

22. Communication, Confidence, & Support Children whose parents agreed to referral Children admitted for services Children identified as at-risk by screenings Children evaluated Children recommended for further evaluation Children referred for further evaluation Children qualified for services 8 13 10 47 57 90 2 2 21 258 1 9 13 31 1 55 2 113 No Data Missing in MIS

23. Communication & Support Children admitted for services Children whose parents agreed to referral Children evaluated Children identified as at-risk by screenings Children referred for further evaluation Children recommended for further evaluation Children qualified for services 8 10 13 47 57 90 2 2 21 258 1 9 13 31 1 55 2 113 No Data Missing in MIS

24. Data Alone Cannot Explain Why

26. Generates relevant questions

27. Provides insight not offered by the data alone

28. Educates and empowers

30. Sample Identification Rate Dashboard Using the ASQ to Identify Children At-Risk for Developmental Delay 1020 1020children received one ASQ (109 children’s records did not meet the criteria for a correct ASQ) 483 children 911 89% of the 1020 children screened received the correct ASQ 191 22% of the 911 children should have been identified as at-risk for developmental delays (conservative estimate based on multiple national samples) 97 11% of the 911 children were identified as at-risk

31. Sample Follow-Through Dashboard What happened to the children identified as at-risk for delay? Children whose parents agreed to referral Children evaluated Children identified as at-risk by screenings Children admitted for services Children qualified for services Children recommended for further evaluation Children referred for further evaluation 8 13 10 47 57 90 2 2 21 258 1 9 13 31 1 55 2 113 No Data Missing in MIS

33. Administrative and supervisory staff

34. Parents

37. Dee Dee and Dahnayl

38. It is critical to have systems in place to monitor the impact of screening services and to identify improvement needs and opportunities.

39. Discussion How can your program utilize currently collected data to better understand the quality of your screening service? What current challenges impact your program’s screening service? How can programs successfully address the needs of staff who provide screening, and EI referral and coordination services to families? How can programs successfully support families through the screening service and EI referral and coordination process? How can programs involve stakeholders in improving: the capacity of programs and staff; and the quality of screening services and supports provided to families?

40. Building Effective Screening Services Understanding the Needs of Programs, Staff, and Families For additional questions, please contact us: Janell Smith-Jones janells@pitt.edu Andrea Rudekarudek@pitt.edu Milena Nigam mkn11@pitt.edu Developmental Screening and EI — OCD Webpage