Change Package Your Team Name: Community Prevention Partnership of Berks County/NFP and PAT teams Topic Area:. DSS Name of the Intervention: Development of an ASQ-3 Referral Matrix Primary Driver: Reliable and effective systems for referral and follow-up

Definition of the Intervention Team developed and tested a decision tree for actions/interventions/referrals based on ASQ-3 scores Team developed an ASQ-3 and ASQ-SE summary sheet to document strengths, concerns, intervention activities or referrals Summary sheet is given to parents and a copy is placed in the chart

Description of the Intervention

Description of the Intervention ASQ-3 and ASQ-SE Summary   Home visitors screen the growth and development of children on a regular basis. They share the results with families , suggest appropriate learning activities and make referrals to Early Intervention Services as needed. Date of screening ____________ Age of child at screening __________ ASQ-3 _______ months ASQ-SE ______ months Child’s Strengths _____________________________________________________________________________________ Areas of Concern No developmental concerns were identified. My child’s score was close to the cutoff. My home visitor suggested the following: __________________________________________________________________________ A referral to Early Intervention was recommended. ____ I received a copy of my child’s screening summary. (Initials) _____ I give permission to share results of my child’s screening with Early Intervention for further (Initials) evaluation. _____ I give permission to share the results of my child’s screening with my child’s doctor. _____ My home visitor recommended a referral to Early Intervention and I declined the referral for my child. _______________________________ ____________________________ _________________ (Parent/ Guardian name- printed ) (Parent/guardian signature) Date (Home visitor name- printed ) (Home visitor signature) Date

Description of the Intervention   Child’s name Date ASQ-3/ ASQSE Timeframe (ie. 2 month, 6 month etc.) Results: Above the cutoff Near the cutoff Below the cutoff Family was presented with EI referral information? Family consented to referral? Date referral was made Evaluation/follow-up notes and information N/A yes or no Family is being provided with specific activities, guidance etc regarding developmental concern or delays Child already receiving EI

How is the intervention carried out? Complete ASQ-3/ASQ SE at intervals suggested by NFP or PAT model Score the screenings and review results with parent/caregiver Record the results on the ASQ-3 and ASQ-SE Summary Sheet Provide the parent/caregiver with the Summary Sheet Place one copyof the Summary Sheet in the client’s chart Discuss children with scores “below cutoff” or with concerns during reflective supervision NFP-enter screenings and results on monthly tracking sheet PAT-enter screening results into data base CQI team will track screening results/interventions and referrals CQI team will provide feedback summary to staff

Evidence that the intervention is effective 95 % of PAT and NFP children with an ASQ-3 or ASQ/SE a score near or below the cutoff *have : Specific activities/plan of care aimed at addressing concern or delay Are already receiving EI services Have had a referral for EI evaluation * screenings October 2014 through August 2015

Evidence that the intervention is effective Nurse-Family Partnership ASQ-3 and ASQ/SE Screenings NFP Berks County PA October 2014 through August 2015 472 screenings 18 (3.8 %) children “below cutoff” 5 of the 18 (27.7 %) were provided with specific activities to support development 8 of the 18 children (44.4%) were already referred to EI and were receiving services 5 of the 18 (27.7 %)were new referrals to EI

Evidence that the intervention is effective Nurse-Family Partnership ASQ-3 and ASQ/SE Screenings NFP Berks County PA October 2014 through August 2015 472 screenings 60 (12.7 %) children “near cutoff” 49 of the 60 (81.6 %) were provided with specific activities to support development 9 of the 60 children (15%) were already referred to EI and were receiving services 1 of the 60 (1.6 %)was a new referral to EI 1 family moved out of the area

Evidence that the intervention is effective Parents as Teachers

Evidence that the intervention is effective Parents as Teachers

Evidence that the intervention is effective Parents as Teachers

Evidence that the intervention is effective Parents as Teachers

Pre-requisites for the intervention What is needed in order to have success with this intervention? Collaboration with EI Education of team members regarding importance of proper screening, accurate scoring, linking families to referral system Revising tools and tracking sheets Strategies for motivating families to allow EI evaluation Strategies to educate home visitors to refer concurrently with suggesting activities/developing plan of care to support development

Advice Barriers / Challenges Key advice to overcome barriers Reluctance of families to accept referral suggestion Build home visitor skills on MI approaches to facilitate acceptance of referral Reluctance of home visitors to refer for a “concern” Team meetings, educational sessions and sharing of “success” stories Adequate documentation of plan of care, referral and follow-up Ongoing; address during supervison, CQI meetings and sharing of results/data with team