WORK PRODUCTS:

ORGANIZATIONS REPRESENTED: Children’s Developmental Services Agency (CDSA), Guilford County Partnership for Children, Partnership for Community Care, UNC – Greensboro, United Way of Greater High Point, YWCA of Greensboro

COMMUNITY PROBLEM: Too many 4-year-olds are not developmentally on track. (Teaching Strategies GOLD Growth Reports, 2015)

CHALLENGE GOAL: Identify where children get developmental screenings, tools used, what happens as a result of the screenings (i.e. referrals made, part of electronic medical record (EMR), etc.) and whether data is available.

READY/READY FRAMEWORK ELEMENT ADDRESSED: SUPPORTED FAMILIES > Sufficient Supports Available for Children > Children have yearly wellness checks & developmental screenings

PERSPECTIVES ENGAGED: Surveyed and consulted with agencies/organizations that provide screenings including Guilford County Health Department, physicians, Guilford County Schools, NC Pre-K providers, Head Start/Early Head Start, Family Services of the Piedmont, Bringing Out the Best and LICC members to better understand landscape. Also asked Family ALT about their experiences with developmental screenings.

ACTIONS TAKEN & ASSOCIATED BEST PRACTICES:

Defined the local problem: Reviewed local kindergarten readiness data and best practices; aligned with Birth to Five: Watch Me Thrive (PDF) report (U.S. Department of Health and Human Services.)

Identified root causes of the problem: Disjointed system of care due to lack of systematic approach to developmental screenings — little coordination among providers, multiple screening tools, lack of confidence that referrals will result in connections, developmental milestone conversations cut short due to time constraints

Assessed fit and capacity of local efforts: Conducted basic survey (PDF) to determine who provides developmental screenings, when/where, tool used, how results are used. Analyzed results to identify gaps and opportunities

WHAT WE LEARNED:

Developmental screening assets:

  1. Screenings conducted in variety of settings (visiting nurses, pediatrician offices, health department, agencies/organizations, child care settings)
  2. Most organizations/agencies are using a recommended screening tool. Ages & Stages Questionnaire (ASQ-3) and ASQ:Social Emotional (SE) are most common; Parents’ Evaluation of Developmental Status (PEDS) used in health care system.

Gaps for developmental screenings:

  1. No common coordinated approach for how screenings are conducted.
  2. No population-level data to determine how many children are on track/off track.
  3. Best practice guidelines (see Bright Futures (PDF) compendium for screenings) recommended by the State of North Carolina; insufficient data to know whether guidelines are being followed.

Early childhood system: Unable to obtain data from pediatric medical homes where majority of developmental screenings occur.

SIGNIFICANT WINS: 

  1. Identified big gaps when it comes to tracking the development of young children.
  2. Best practice protocols are available, which can support efforts to create systematic approach to developmental screenings.
  3. Identified local effort within a pediatric practice that could serve as an effective implementation model (parenting education embedded within well-child checkups)

RECOMMENDATIONS: 

  1. Convene a larger team with a variety of expertise in this area to develop systemic approach, including (among others): members of the current team, ABCD, local health systems representatives, Guilford Child Development, Guilford County Dept. of Health (from variety of perspectives), Guilford County Partnership for Children, Guilford County Schools, Partnership for Community Care, TAPM.
  2. Implement ASQ-3 and ASQ:SE system-wide in all pediatric medical homes as this is the evidence-based standard for developmental screenings.
  3. Provide supports within pediatric medical homes to ensure screening tools are implemented to fidelity, i.e. health navigators who help families complete screening, understand results and track progress.
  4. Collect ASQ-3 and ASQ:SE data on population level basis to identify community-wide trends and track progress.
  5. Build families’ knowledge about developmental milestones and screenings. i.e. waiting room videos about developmental milestones, serve and return, local resources, etc. [Examples of communication resources: Developmental Screening Passport (PDF), Developmental Milestones Tracker (Spanish) (PDF);  Developmental Milestones Tracker (English) (PDF), Bright Futures/American Academy of Pediatrics’ schedule for screenings/immunizations (PDF).