Philadelphia Nurse-Family Partnership and Mabel Morris Home Visitation Programs Topic Area: Developmental Support and Screening (DSS) Name of Intervention: Making ASQ-3 Intervention activity sheets (“ASQ-3 tool”) more user friendly by color-coding areas of development and adding a Community Resource list. Primary Driver: Engage families in promotion of healthy development.

Inspiration After months of DSS data collection in weekly 1:1 supervision, Nurse Supervisors (NS) and CoIIN Team began asking… "what does individualized developmental support mean to us?" "what are Nurse Home Visitors (NHVs) using/doing to prepare this support?" "with the busy schedules of NHVs, what can we do to cut down time spent preparing/researching activities to do with families?" CoIIN Team decided to survey NHVs to ask about their confidence in providing individualized developmental support, what resources they were using, and if further support would increase their confidence.

Describe the Intervention Survey NHVs to determine need for individualized developmental support tool. Once need is identified and tool is created, re-survey NHVs to assess confidence in providing individualized developmental support and rate helpfulness of tool.

Define the Intervention Make ASQ-3 Intervention Activity sheets (“ASQ tool”) more user-friendly by color-coding each area of development (gross motor, problem solving, etc.) and adding a Community Resource list. We predict that this intervention will increase Nurse-Home Visitor (NHV) confidence in providing individualized developmental support to families.

Implementing the Intervention Give survey to one team of NHVs to assess confidence level in providing individualized developmental support to families after use of ASQ-3 developmental screening questionairre. Inquire about resources NHVs use to engage families in promotion of child development. Use survey results to inform decision to create tool that all NHVs can use. CoIIN Team discusses existence of ASQ-3 Intervention Activity Sheets ("ASQ tool")and decides to enhance this tool rather than create a new one. Color-code areas of development (gross motor, problem solving, etc.) on ASQ-3 tool. Compile list of resources that support child play and development throughout local community and add to back of tool. Select small group of NHVs to test enhanced tool and give feedback by taking survey. Adjust tool using results of survey. Train all NHVs on use of tool to increase awareness. Gather qualitative feedback. Implement tool site-wide by adding to ASQ-3 screening packets.

Enhanced ASQ-3 Tool Note: permission obtained from ASQ-3 Customer Service to code tool by development area.

Our Community Resource List

Implementing the Intervention cont’d Cycle 4: (July 2015 ) NHV from CoIIN team trains all NHVs on use of the tool and gathers qualitative feedback . Cycle 3: (June 2015 ) Members of CoIIN Team further develop tool by color-coding areas of development and adding Community Resource list on back of tool. NHVs provide feedback on updates. Cycle2: (May 2015) CoIIN Team decides to enhance ASQ-3 Intervention Activity sheets (“ASQ tool”). 2-3 NHVs will utilize enhanced tool following administration of ASQ-3 screening. NHVs will take survey to rate confidence level in providing individualized developmental support to families and helpfulness of tool. Cycle 1: (April 2015 ) Conduct a survey with one team of NHVs to identify how confident NHVs feel providing individualized developmental support to families. Survey results support need for tool.

Evidence that the intervention is effective Initial DSS Survey ("…assess confidence level in providing individualized developmental support to families after use of ASQ-3 screening") Nurse Home Visitor (NHV) Confidence in providing individualized developmental support* Would list of developmentally appropriate activities increase your confidence? (Y/N) #1 5 Y #2 4 #3 #4 #5 #6 3 #7 1 *scale = 1-6 (not confident to very confident) *scale = 1-6 (not helpful to very helpful)

Evidence that the intervention is effective cont’d Survey results after tool enhancement ("…small group of NHVs to test enhanced tool and give feedback by taking survey") Testimonies from NHVs after use of enhanced tool: “It is very helpful to have the activities coded according to the areas of need of the child”. “The…coding made it easier to use. I am excited to use the resource list with my families”. NHV Confidence before use of tool* Confidence after use of tool Helpfulness of tool** #1 5 6 #2 4 *scale = 1-6 (not confident to very confident) **scale = 1-6 (not helpful to very helpful)

Pre-requisites for the intervention What is needed in order to have success with this intervention? ASQ-3 screening built into your program curriculum Age-appropriate ASQ-3 Intervention Activity sheets List of resources in your communitiy where families can take their children to learn and play Team members (NS, NHVs) dedicated to: Creating and analyzing surveys to gather NHV feedback Coding the ASQ-3 Intervention Activity sheets according to areas of development Compiling list of fun and interactive community resources Trialing the tool with families and giving feedback Attaching tool to ASQ-3 screening packets

Guidance Barriers / Challenges Key advice to overcome barriers Staff time to code tool and compile Community Resource List Have sub-set of CoIIN Team with NS and NHVs to break up tasks Family cancelling visits when tool is scheduled to be trialed Have several staff (>=5) who are planning to trial the tool Train all NHVs in use of tool Have dedicated NHV attend Team Meetings to train multiple staff at once. Use sign-in sheet to track training and have NS follow-up with staff members who were missed. Limited resources for color copying/printing Give nurses ideas for helping families to recognize codes without color printing (stickers, markers)

Our Experts Members of the Philadelphia Nurse-Family Partnership and Mabel Morris CoIIN Team CoIIN Lead – Ann Ridder, NHV (aridder@nncc.us) Nurse Supervisors (NS) – Erin Graham (egraham@nncc.us), Breanne Ward (bward@nncc.us) Nurse Home Visitors (NHVs) – Chowan Cowans (ccowans@nncc.us), Lizz Tooher (etooher@nncc.us)