The Concerns Of Parents at High Psychosocial Risk: Can Families in Crisis Identify Developmental-Behavioral Problems in Their Children and Follow Through with Referral Recommendations? Patricia Herrera, MS, Developmental Screening and Care Coordination 211 LA County, San Gabriel, CA Frances P. Glascoe, PhD, Pediatrics, Vanderbilt University ,Knoxville, TN

Disclosures Human Subjects 211 LA has no financial relationship with any commercial organization producing healthcare products or services. Human Subjects IRB permission was obtained for use of the de-identified data used in this study.

The study addresses these questions: 1. Are families in crisis willing to spend time on DB screening? 2. Do their children have elevated needs for health and DB services? 3. How well do families follow-through with referral recommendations? 4. How do early detection and follow-through rates compare to general pediatric samples?

Background 2-1-1 is a national call line serving annually 16 million families with non-emergent crises (e.g. ,eviction, food or housing instability) 211 Los Angeles (211LA) receives ½ million calls per year and provides on-line developmental-behavioral screening.

Methods and Procedures 211 LA Information and Referral (I&R) Specialists offer screening to parents/caregivers with children 0-5 with stated and unstated developmental concerns. 211 LA I&R Specialists warm transfer all calls to a Care Coordinator Specialists that has been trained to conduct the screening and conduct the needed care coordination for a child at risk for a delay/disability to receive intervention services.  Patricia, I know you gathered lots of demographic data apart from PEDS Online but we have to keep this short. I recommended simply reading the methods/procedures/ and measurement slides and getting through these quickly

Methods and Procedures (cont) 3. All screening results and essential demographic data were captured by the PEDS Online database. 4. For 211 LA, data were then transferred to 211 LA’s electronic health record; 5. The status of 211 LA referrals and whether a referral resulted in delivery of services were tracked in 211 LA’s database.  Patricia, I know you gathered lots of demographic data apart from PEDS Online but we have to keep this short. I recommended simply reading the methods/procedures/ and measurement slides and getting through these quickly

Subjects Community Pediatric Practices 70% of 211LA parents (N =3919) whose children were in the targeted age-range agreed to complete screens. Community Pediatric Practices Data on children of comparable ages from 12 general pediatric clinics across 6 US States where PEDS Online screens was administered by interview at well-visits, served as a comparison group (N = 8367).

Measurement PEDS Online, which has automated scoring and report-writing, was used to support interview administrations and referral decisions via: Parents' Evaluation of Developmental Status (PEDS) PEDS: Developmental Milestones (PEDS:DM) The Modified Checklist of Autism in Toddlers (M-CHAT) Patricia, since your slides will be printed in the program, it is probably wise to keep within the URLfor PEDS Online, to minimize questions about how to find it and allow time for more probing questions and ideas. But I wouldn’t read aloud that bit www.pedstest.com/online

PEDS and M-CHAT Results and Referral Decisions aAs a standard, all referrals included vision, hearing and lead screening, as well as recommendation of early childhood education programs. PEDS and M-CHAT Results and Referral Decisions Screening Outcome Description of Concerns Typical Referrals PEDS Path A High risk of developmental disability Multiple developmental and frequent behavioral concerns Further evaluation Specialty referrals if warranted (medical, mental health) Early intervention (age 0–2 years) or early childhood special education (age 3–5 years) PEDS Path B Moderate risk of developmental disability At least one developmental concern and other behavioral concerns Further evaluation if warranted Early intervention or early childhood program PEDS Path C Elevated risk for behavioral or mental health problems Behavioral or mental health concerns but no developmental concerns Early intervention program PEDS Path E Low risk of developmental disability No concerns of any type Early childhood program such as Head Start Annual re-screening M-CHAT: Fail Shows possible signs of an autism spectrum disorder Refer to state's developmental disability regional center for autism diagnostic evaluation Follow PEDS referral pathway per developmental screening results M-CHAT: Pass No signs of an autism spectrum disorder. Other developmental concerns may still be present.

Demographic Results *US Census Bureau, 2013

Screening Test Results General pediatric clinics tend to refer ~ 39% of children with failed screens and referral uptake is completed by only about ½ of this group, i.e., ~20% of families.1 211LA referred 100% of uninsured children and those with delays: 57% were successfully connected to SCHIP, Head Start, Early Head Start, IDEA programs, etc.

Referral/Outcomes Results 211LA referred 100% of uninsured children and those with delays: 57% were successfully connected to SCHIP, Head Start, Early Head Start, IDEA programs, etc. General pediatric clinics, based on existing studies, refer ~ 39% of children with failed screens and referral uptake is completed by only about ½ of this group, i.e., ~20% of families.1-2 Patricia you will want to flesh this out or create another slide?

Conclusions Parents, even in the midst of financial crises and stressful living situations are willing to discuss worries about their children; Families with high rates of psychosocial risk have children with high rates of developmental-behavior problems and health concerns; Live referrals to services have a high uptake rate as compared to other referral methods (e.g., fax, email, requiring parents to make their own appointments, etc.).

References Guevara JP, Gerdes M, Localio R, et al. Effectiveness of Developmental Screening in an Urban Setting. Pediatrics. 2013;131:30–37 Hix-Small et al (I can find this) Acknowledgements This project was funded by W.M. Keck, Weingart and S. Mark Taper Foundations with matching grants from the Robert Wood Johnson Foundation Local Funding Partnerships and First 5 LA