the Connecticut public health association’s 2017 annual conference Right from the start Integrating statewide systems within a local community to support children’s optimal development and health equity the Connecticut public health association’s 2017 annual conference October 30, 2017 I am very pleased to have this opportunity to share with you the work Child Development Infoline (CDI) is doing with our Norwalk partners in this Child Development Infoline (CDI) Norwalk Early Childhood Initiative. Before I get started, I want to introduce two individuals who are here with me today and who play pivotal roles in this effort. Kareena DuPlessis and Linda Francisovich This work has evolved from a three grant with a one year no cost extension from the Grossman Family Foundation to a new 5 year grant that includes an evaluation component to truly determine if we are having an impact on Norwalk’s young children and their families.

RIGHT FROM THE START The early years of life (0 to 8) form the foundation for future health, development and overall success. Health equity means ensuring that everyone has equal access to opportunities that allow for healthy and productive lives. Screening, early identification and linkage to services can catch vulnerable children who are at risk for negative outcomes and stop the progression of risk. The Help Me Grow system serves as an effective vehicle for screening, early identification and linkage to services. We titled this presentation right from the start to recognize the science of early brain development and because the research suggests that many disparities in overall health and well being start in early childhood and that health equity means that everyone has equal access to opportunities that allow for healthy and productive lives. We know that screening, early identification and linkage to services can catch vulnerable children who are at risk for negative outcomes and stop the progression of risk. Screening, early identification and linkage to services is a health equity vehicle that helps to achieve our project’s goal of all Norwalk’s children enter kindergarten developmentally ready to learn. It is important to stress that a successful system must include all three components – screening, early identification and linkage to service, which is the HMG system. The HMG system was developed in CT and is now a model that is being replicated, not only in Norwalk, but in over 28 states under the auspices of the National HMG Center located at CT Children’s Medical Center.

Child Development Infoline’s Norwalk Early Childhood Initiative Implemented a city-wide Help Me Grow system Centralized access point Outreach to families and community providers Outreach to health care providers Data collection and analysis Imbedded Child Development Infoline within the City of Norwalk Is creating an early childhood system by: Establishing an integrated system of services and supports Understanding the importance of developmental screening Using the Ages and Stages Questionnaire (ASQ) child monitoring tool as a common agenda Informing policy, methods for tracking activities, and measuring outcomes using a cross sector approach. Is exploring replication in other communities and on a state level The HMG system has 4 components with the hub being the centralized access point, which in CT is CDI. CDI is a specialized call center of 2-1-1. It is staffed by care coordinators who provide education and support, care coordination, advocacy, when needed, and follow up with families. The other HMG components are outreach to families, community-based & health care providers & data collection and analysis. The Norwalk initiative allows for maximizing the combined efforts of state level resources with the local efforts. Specifically, CDI offers an access point for support, education and connection to services to families and providers. It also functions, in collaboration with other data collection touchpoints, as the resource for collecting and analyzing data. The community partners, well known and trusted organizations and individuals, take the lead in outreaching to families, community providers and health care providers. It was a match made in heaven allowing for the creation of an early childhood system that includes: Establishing an integrated system of services and supports Understanding the importance of developmental screening Using the Ages and Stages Questionnaire (ASQ) child monitoring tool as a common agenda Informing policy, methods for tracking activities, and measuring outcomes using a cross sector approach. We are also looking at possible replication opportunities in Stamford and Bridgeport.

Project Goal: Norwalk children enter Kindergarten ready to learn Micro Ensure families have access to information, referrals, and help navigating health/behavioral health systems: Increase routine screenings as early as possible Identify children with developmental concerns and connect to services as needed Macro Use data on child development to inform: decisions related to resource allocation policy development This project, designed to ensure that Norwalk children enter kindergarten ready to learn, operates on both a micro and macro level.

Why do formal developmental screening? Without screening tools With screening tools Developmental Disabilities 30% identified Palfrey et al, 1994 70-80% identified Squires et al, 1996 Mental Health Problems 20% identified Lavigne et al, 1993 80-90% identified Sturner, 1991 Creating a system that utilizes a formal developmental screening tool is pivotal to the success of this initiative. These studies reinforce the need for doing formal developmental screenings. They show what happens when those in a position to do formal developmental screenings don’t. [Review info in chart] Some obvious developmental and mental health issues are identified, but many are not. In these situations health equity is compromised often with long term consequences that could have been avoided. The screening tool we are using is the ASQ.

Developmental Screening: Why the ASQ? Validated tool with diverse populations Family-friendly: A tool for parents Used with general and at-risk populations Fosters parents’ understanding of development (promotes development) Endorsed by American Academy of Pediatrics Has been used as an outcome measure in public health studies, home visiting programs and early head start There are other screening tools, but these factors contribute to our decision to use the ASQ.

Project Accomplishments Identified champions and work groups Obtained the approval/was adopted by Norwalk Early Childhood Council Aligned our efforts with Norwalk ACTS Engaged ECE and home visiting providers Created a universal home visiting referral form Given state-level visibility: the CT HMG Advisory Committee Formed a CQI group to own the work: PDSA cycles The first 5 bullets are accomplishments reflective of a state and local partnership on the community level. Identified champions and work groups Obtained the approval/was adopted by Norwalk Early Childhood Council Aligned our efforts with Norwalk ACTS Engaged ECE and home visiting providers Created a universal home visiting referral form These are lessons learned blueprint activities that can be replicated elsewhere. This Norwalk based initiative has state level visibility. An example of this is it’s membership on the state level HMG Advisory Committee meeting. The establishment of a Continuous Quality Improvement (CQI) Committee and the use of Plan Do Study Act (PDSA) cycles shows a maturity of the project. It has a fairly sophisticated structure and process that moves the agenda in an organized and measurable manner.

Indicators: How do we know if the CQI process is working? Measures of success Total # of community partners Percent increase in total # of community partners Total # screens Total # repeat / routine screens Percent increase from 201x-201x in total # of screens Total # of children screened routinely at different age levels # of children identified with developmental concern # of children with developmental concern referred for services

Where are we now? Institutionalizing developmental screening as early as possible (i.e., 0-3) through 5 years of age via School Readiness programs Home visiting programs Identifying children with developmental problems and connecting families to services as needed ASQ scores/parent comments indicating a concern CDI care coordinators contact families Continuous Quality Improvement (CQI) process: Modeled after Help Me Grow Collaborative in Michigan Plan-Do-Study-Act (PDSA) cycles

Resources Child Development Infoline Website: cdi.211ct.org Developmental Screening Toolkit: http://www.eccsct.org/toolkit/

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