With a Focus on ASQ3 Developmental Screening Presenter: Roberta Payne

 Part I : Overview  Part II : Recommended Tools  Part III : Referral Process  Part IV: Implementation Strategies  Part: V Data Driven Goal Setting

Identify developmental screening and early intervention as a valuable CECC goal Learn how tools to screen for developmental delays might be used How programs may Implement referral procedures for children who fail or pass but exhibit potential developmental concerns to expedite Early Intervention Employ parent/caregiver education materials as a strategy Learning Objectives Learning Objectives

 20% of mental health problems identified (Lavigne et al. Pediatr. 1993; 91: )  30% of developmental disabilities identified (Palfrey et al. JPEDS. 1994; 111: )  80-90% with mental health problems identified (Sturner, JDBP 1991; 12:51-64)  70-80% with developmental disabilities correctly identified (Squires et al., JDBP 1996; 17: )

Early Brain Development

Americans with Disabilities Act (ADA) 1990 Individuals with Disabilities Education Act (IDEA) 1975 (Amended in 2004)

 Developmental or Behavioral Disorders ◦ Speech and language issues ◦ Mental retardation ◦ Learning problems ◦ Attentional disorders ◦ Other behavioral difficulties  only ½ of children with these problems identified prior to school entrance

 Development exists on a continuum  Children manifest skills variably, inconsistently  Latent period  Developmental problems increase with age ◦ 2-3% of 0-18 month olds ◦ 10% of month olds ◦ 16% of 0-21 year olds

 Parents are reservoirs of rich information  Screening structures observations, reports, and communication about child development  Screening becomes a teaching tool for parents and child care professionals  Screening improves relationships

 Explain tool and purpose to parents  Discourage assumption of a “problem” ◦ addressing behavioral and developmental issues is an important part of your service  Assess ability to complete tool properly ◦ with assistance? ◦ in center or at home?

 Focus on positives  Practice your language “Learning too slowly” “Delayed in some areas” “Needs some extra attention and support”

 Stress the need for further evaluation and follow-up  Offer parents activities they can do right away  Help the parent to inform others

 Acknowledge parent’s fear  Avoid judging parents  Encourage communication, particularly when recommendations are not followed  Provide parent with information on the referral  Set a follow-up

 The importance of information to parents: ◦ Must explain situation to others ◦ Language barriers ◦ Logistics  “Demystify” the process

Developmental Screening is:  Recommended by AAP  Beneficial to all children  Challenging but rewarding to implement  Provides critical data for planning and decision making

 Sensitivity  Specificity  Positive predictive value  Validity  Reliability

 Scoring  Training  Administration

 Parent report tool with exercises, items  Covers 5 skill/developmental areas  Written at a 6 th grade level  Available in Spanish, English, and French  Choices of responses (yes, sometimes, not yet)  Requires minutes to complete, 5 minutes to score  21 color-coded age-appropriate questionnaires and score sheets

Using the shapes below to look at, does your child copy at least three shapes onto a large piece of paper using a pencil or crayon, without tracing? Your child’s drawings should look similar to the design of the shapes below, but they may be different in size. Yes Sometimes Not Yet   

Use ASQ Information Summary sheet to score and for child’s permanent record Ensure test is complete Convert responses to point values: yes (10), sometimes (5), not yet (0) Add item scores by developmental area and record totals Use ratio scoring procedure for unfinished sections

Refer or Follow-up

Ages & Stages ™ Questionnaire The specific answers to each item on the questionnaire can be recorded below on the summary chart.

 1 in 88 children  Age of diagnosis falling  Parent concern ~18 months of age  Early detection crucial

Distinguishing characteristics of children with autism at mental age of months: ◦ Lack of joint attention ◦ Lack of eye gaze to determine others’ intentions ◦ Lack of proto-declarative pointing ◦ Using another person’s body as a tool ◦ Failure to “show objects” to adults ◦ Lack of initiation ◦ Lack of symbolic play

Absolute Indications for Immediate Evaluation- Refer to Early Intervention System 12 months: No babbling, pointing, or other gestures 16 months: No single words 24 months: No 2-word, spontaneous phrases (not echolalic) Any age: Any loss of any language or social skills

 *Ages and Stages Questionnaire, Third Edition (ASQ-3), Brookes Publishing  Ages and Stages Questionnaire - Social Emotional, (ASQ:SE) Brookes Publishing  *Batelle Developmental Inventory 2, Screening Test (2005) Riverside Publishing  *Brigance Infant & Toddler Screen, Curriculum Associates, Inc.  *Brigance Early Preschool Screen II, Curriculum Associates, Inc.

 *Brigance Preschool Screen II, Curriculum Associates, Inc.  *Denver II, Denver Developmental Materials, Inc.  *Developmental Observation Checklist System (DOCS), PRO-ED  *Developmental Indicators for the Assessment of Learning (DIAL) III, Pearson  Learning Group

 *Early Screening Inventory – Revised (ESI-R), Pearson Learning Group  *Early Screening Profile, Pearson Learning Group  Learning Accomplishment Profile (LAP - D) Screen, Kaplan Early Learning Co.  * Assesses all 5 domains: Adaptive, Cognitive, Communication, Motor, and Social / Emotional

 Prevention Programs ◦ at risk  Early Intervention ◦ birth to age 3 ◦ Suspected delay ◦ qualifying condition  Special Education ◦ Age 3 to 21

 Early Head Start and Head Start ◦ serves birth-3 and 3-5 year olds ◦ comprehensive health and education services ◦ low income families

 Early Head Start and Head Start ◦ serves birth-3 and 3-5 year olds ◦ comprehensive health and education services ◦ low income families  HANDS ◦ serves birth-up to age 3, first time parents ◦ voluntary, home visitation program

 Early Head Start and Head Start ◦ serves birth-3 and 3-5 year olds ◦ comprehensive health and education services ◦ low income families ◦ serves birth-2, serves first time parents ◦ voluntary, home visitation program  Child Care Resource and Referral ◦ connect to child care services and subsidies ◦ Training for child care professionals

 Who you should be referring to EI (First Steps)  When to refer - timeline for evaluation/services  Where to refer  What specific services the EI system provides

Children Aged 0-3 with a Developmental Delay  Cognitive abilities  Physical abilities - including vision and hearing  Language/speech/communication  Social-emotional abilities  Adaptive self-help skills ◦ At risk of substantial developmental delay

First Steps  15 Offices in State of Kentucky  Functions: ◦ assist in screening/evaluation ◦ determine eligibility ◦ assess needs ◦ plan for services ◦ identify providers

 Occupational therapy  Physical therapy  Speech/language therapy  Family training, counseling, support  Service coordination  Audiology  Vision services  Nursing  Nutrition  Psychological services  Social Services  Developmental therapy  Transportation  Medical diagnostic services

 Autism  Deaf-Blindness  Deafness  Emotional Disturbance  Hearing Impairment  Mental Retardation  Multiple Disabilities  Orthopedic Impairment  Other Health Impairment  Specific Learning Disability  Speech/Language Impairment  Traumatic Brain Injury  Visual Impairment 3-5: Special Education

 Designate steps for making a referral  Designate person(s) to whom a referral may be made  Identify information to be provided  Provide assistance necessary to meet requirements  Identify process for providing parents with notice of their rights

2 Working Days 45 Days For EI Identification Referral for Evaluation and Assessment (service coordinator assigned) Evaluation/Assessment Eligibility Determined IFSP Developed IEP Developed 60 Days For Spec Ed

QUESTIONS:  Which tools at what intervals?  How do Programs make time for screening?  Who administers the screening, scores the tests, and communicates results and documents data outcomes?

ANSWER:  The Team Approach ◦ Solves problems ◦ Generates new ideas ◦ Encourages participation ◦ Requires training

Tools can be:  Distributed at designated times to be completed and brought back  Completed at enrollment or entry to program  Completed by phone interview  Completed through a community screening event

Program Directors  establish the system  choose the tools  train staff  provide feedback to parents  advise parents on development and behavior Front Line Staff  implement the system  score questionnaires  provide routine feedback  distribute parent education  maintain and update referral lists

Insuring Every Child is Ready to Grow, Ready to Learn and Ready to Succeed in School Establishing a Goal for Implementing a Screening and Referral Program in You Community

“ Goals are the fuel in the furnace of achievement” Brian Tracy Contact Information: Roberta Payne Breckinridge Grayson Programs Inc. 201 E Walnut Leitchfield, KY (270)