The Norwalk Story: How one community is using the Ages and Stages Questionnaires (ASQ®) to build a system for developmental screening for young children

The Norwalk/CDI Early Childhood Initiative A Unique State and Local Partnership Innovation Funded by the Grossman Family Foundation State Partners Child Development Infoline Center for Social Research, University of Hartford The Help Me Grow Advisory Committee Community Partners Family & Children’s Agency Norwalk ACTS Members of the CQI Core Committee Members of the Advisory Committee

Initiative Description Implementing the Help Me Grow system within a local community Doing early childhood system building work in Norwalk Establishing an integrated system of services and supports Understanding the importance of developmental screening Using the Ages and Stages Questionnaire (ASQ) as a common agenda Informing policy, methods for tracking activities, and measuring outcomes using a cross sector approach. Providing tools for replication in other communities and on a state level

Goals of Initiative Norwalk will have a multi-level sustainable infrastructure in place to support early screening, identification of needs and linkage to services. Norwalk children will enter kindergarten developmentally ready to learn. Tools to inform and support replication efforts will be developed. Research evaluating the impact of developmental screening will be conducted and shared.

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

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

% on track and % who stay on track over time ASQ Developmental Indicators – what are we measuring? % on track and % who stay on track over time % at potential risk for delay and % with reduction in delay over time % at strong risk for delay and % with reduction in delay over time Tiered Interventions: For on track children: provide developmental promotion activities For children with a potential risk for delay: provide additional activities related to area in monitoring zone For children at high risk for delay: make referral for a formal evaluation to Birth to Three or Preschool Special Education Services

The Norwalk Story: Where did we begin? Developed a coalition of the willing – began our work with those already utilizing the ASQ in different sectors Used the early adopters to engage new providers in the work of the Initiative Developed messaging around the importance of developmental screening targeted to families and providers Hired a full time ASQ Community Liaison at FCA Policy statement around developmental screening created for Early Care and Education providers Developed CQI process: Plan-Do-Study-Act (PDSA) cycles

Where are we now? Institutionalizing developmental screening as early as possible (i.e., 0-3) through 5 years of age Identifying children with developmental problems and implementing universal tiered intervention protocols to be used across all sectors

Initiative’s Accomplishments Aligned our efforts with Norwalk ACTS Utilized one central data system (Brookes Publishing) for inputting all ASQ screens in the community allowing for data linkages and longitudinal data analysis The Early Childhood Council adopted a policy mandating that School Readiness programs use the ASQ Collaborated with Norwalk Public School District around tracking children’s development ASQs are now included in the kindergarten registration packets Selected to participate in a national PN (Prenatal) to 3 Impact and Improvement Network – all staff in 5 home visiting programs are now utilizing the same 2-step ASQ administration model

More of the Norwalk Story An ASQ Community Liaison who is responsible for supporting and overseeing all providers utilizing the ASQ, engaging new providers in the work, and being the face of developmental screening for Norwalk Developed an Advisory Group – key community stakeholders who can help us reach other sectors around the importance of developmental screening We are now moving into two new sectors – family childcare providers and pediatricians Critical support of the community from Child Development Infoline and University of Hartford’s Center for Social Research

Lessons Learned The importance of a common agenda – need to begin by educating the community on the value of developmental screening The ASQ is a tool that can create common language between parents, early care and education providers, home visitors, and pediatricians Partnership with Norwalk Early Childhood Council and Norwalk Public Schools helped us to create a system for developmental screening The ASQ is a parent tool – there is value in shifting from provider completion to parent completion Having one person overseeing the work is a key to success (ASQ Community Liaison) We are creating better outcomes for children with a successful state-local partnership