Grow Along with Me Supporting Families in Healthy Child Development Mark Moland Manager Children’s CARE Services Sharon Myck Manager Wellness and Community Health

Why? “…the early years of development from conception to age six, particularly for the first three years, set the base for competence and coping skills that will affect learning, behaviour and health throughout life.” (The Early Years Study, McCain & Mustard, 1999)

Overview What is Grow Along with Me? (5) Developmental Checkups (10) Continuum of Services (20) –Building Community Capacity –CORE Groups –START –Clinical Services Collaboration (10) Summary (5)

What is “Grow Along with Me”? –Partnership/Structure – handout –Staffing –Developmental Checkups –Community Capacity Education/Information On- Site Visits Training –Core Groups –START –Evaluation Participatory approach University of Lethbridge

Where What is “Grow Along with Me”?

Grow Along with Me Project Goals To develop a comprehensive continuum of services for children between 18 and 36 months of age. There is a strong focus on prevention as well as enhancing intervention services. To identify children (18-36 months of age) who may have a developmental delay as early as possible using a standardized instrument (i.e., the Ages and Stages Questionnaire). What is “Grow Along with Me”?

Structure Steering Committee –Communications Subcommittee –Evaluation Subcommittee –Education Subcommittee Staff Committees What is “Grow Along with Me”?

Staffing Original Proposal –5.4 FTE Grow Along with Me Educators –4.0 FTE Infant Preschool Development Educators (IPDE) –3.0 FTE Speech Language Pathologists (SLP) –0.5 FTE Occupational Therapist (OT) –1.0 FTE Clerical Support –0.8 FTE Health Analyst It is important to acknowledge the significant in-kind resources that have been dedicated towards this project. What is “Grow Along with Me”?

November 24 – December

Staffing Collaboration across professions, departments and organizations and Ministries What is “Grow Along with Me”?

Evaluation Approach What is “Grow Along with Me”?

Evaluation Approach Focus on process and outcomes Strategic approach utilizing qualitative and quantitative methods. What is “Grow Along with Me”?

Developmental Checkups

Developmental Checkups Recommended Frequency 6 Month Well Child Clinic Visit 18 Month Well Child Clinic Visit Developmental Checkups

6 and 18 Month Well Child Clinic Process Parent is scheduled to attend the appt 15 minutes prior to the time they will meet with the nurse Parent completes ASQ Nurse reviews completed ASQ with parent during visit Nurse provides information, anticipatory guidance and referrals as required Developmental Checkups

One time per year between 24 months and 60 months of age. Community Developmental Checkup sessions in the spring of the year Parent Link Centers Parents as Teachers Home Visitation Some regulated child care facilities and private preschools Developmental Checkups Recommended Frequency Developmental Checkups

These numbers include only ASQs that were completed and received by Children’s CARE Services Developmental Checkups

There were 2614 more ASQs completed in 2008 than % increase! Developmental Checkups

“I found it reassuring to know where my little guy was (in relation to developmental milestones)” (Parent comment) Developmental Checkups

Q3 (October – December) 2008/09 Estimated number of Children who turn 18 months in quarter 698 # of ASQs completed and returned to CARE (18, 20, 22 month intervals) 366 Estimated percentage of coverage52% Approximate Coverage Rate for 18 Month Developmental Checkup October – December 2009 Developmental Checkups

Q3 (October – December) 2008/09 # of Children who turn 6 months in quarter733 # of 6 Month ASQs completed and returned to CARE 320 Estimated percentage of coverage44% Approximate Coverage Rate for 6 Month Developmental Checkup October – December 2009 Developmental Checkups

Summary of Concerns Q1-Q3 2008/09 for 18 – 36 Month ASQs Developmental Checkups

Summary of ‘Other Concerns’ in Quarter 2 – 2009 (n=54) ConcernNumber Speech Development (e.g. delayed speech, dropped sounds, articulation 22 Behavioral Concerns (e.g. temper, biting, hitting, tantrums 10 Nutrition/eating concerns 7 Referral declined 6 Other (fine motor, flat head, persistent cough, rash, scrunching ears, sleeping) 5 Motor skills (e.g. falls, stance) 4 Developmental Checkups

Absolutely! One example of a developmental check I learned was to test for putting items in a bottle to see if my son would turn them upside down to get them out. We had never spent time before using all the little things to be aware of. Another example is pouring sand from bucket to bucket. I guess it just changes the way we play now—it moves the focus onto developmental growth. Phone Interview Question: Did the ASQ provide parents with the opportunity to learn about activities that supported their children’s development at home? Developmental Checkups

Continuum of Services of

Building Community Capacity Capacity building refers to the means by which a community can tap into its own strengths. "Capacity building places the emphasis on existing strengths and abilities, rather than being overwhelmed by problems or feelings of powerlessness" (HRDC, 1999). Continuum of Services

There is certainly more than just myself to rely on to help my child become an invaluable part of the community by starting him off on the right path. Thank U. (Parent comment regarding the Community Based Developmental Checkup) Learning the areas that I can help improve with my child before pre-k. (Parent comment regarding the Community Based Developmental Checkup) Continuum of Services

Community Capacity Comprehensive Communication Plan –Website –Information Resources Onsite Visits Community Education Sessions Connections Continuum of Services

Quarter 3 (Q3) website utilization data reflects a continued demand for the ‘Grow Along With Me’ website information. Nearly ¾ of hits are new visits (69.3%), reflecting an ongoing interest in the GAWM web site Continuum of Services

Onsite Visits Continuum of Services

In-services Available TALKING TAKES TIME TAKING A CLOSER LOOK AT COMMUNICATION SHARING CONCERNS WITH PARENTS FINE MOTOR DEVELOPMENT IN TODDLERS (12-36 MONTHS) PARTNERING with PARENTS when using the AGES & STAGES QUESTIONNAIRE® AGES & STAGES QUESTIONNAIRE ® (ASQ) WHEN WILL I GET A GOOD NIGHT SLEEP TEACHING TOOLS FOR CHILDREN WITH CHALLENGING BEHAVIOURS Continuum of Services

Other Communication Initiatives Launch Wellness Show Community-Based Developmental Checkups Continuum of Services

Core Education You Make the Difference (Hanen) Learning, Language and Loving it (Hanen) Target Word (Hanen) COPEing with Toddler Behavior Parenting the Strong Willed Child Responsive Teaching Who runs them…. Continuum of Services

Providing Parents and Communities with more tools The ‘right’ time The ‘right’ place The ‘right’ tools These steps benefit everyone! Continuum of Services

Families creating positive outcomes… Good timing Relationship building Families take on many shapes and forms Building rich experiences Continuum of Services

Access: Parent and Service Provider Education Continuum of Services

Access: Groups Barriers –Child care –Trained Staff –Transportation Continuum of Services

Parent Video or Story

Quotes from parents who have attended groups “I am grateful for childcare” “My child benefited from the opportunity to interact with other children” “Without childcare, I couldn’t attend” “I learned what to do vs. what not to do” “Home is more peaceful and positive” “Best skills I learned: attending and rewarding” Continuum of Services

START Short intervention times Term limited A broad based Assessment Responsive Action Team Continuum of Services

Integration with Clinical Services Continuum of Services

Pathway Audit Continuum of Services

Cultural Responsiveness Building on partnerships and adapting services to reach our community Napi Takes a Walk By Rebecca Many Grey Horses & Helen Kromm Continuum of Services

Collaboration “Coming together is a beginning. Keeping together is progress. Working together is success.” Henry Ford

Collaboration Structure –Steering Committee –Sub Committees –Collaborative Staff Meetings Evaluation and Improvement –Survey –Focus Group –Priority Setting Synergy Collaboration

Domains Identified Sustaining Factors Architectural Factors Foundational Factors Benefits of Membership Level of Satisfaction Collaboration

Strengths Foundational factors Architectural factors Sustainability factors A clear vision, mission, and goals statement Creation of three sub- committees Mutual respect Regular meetingsEstablishment of terms of reference Collective problem- solving Facilitative and supportive leadership Use of information technology Transparency of project information Grassroots involvement Collective adherence to established project processes Strong skill set of its members

Opportunities for Improvement Foundational factors Architectural factors Sustainability factors Collective understanding of project goals and objectives The establishment of a sustainability sub-committee Constructive approaches to feedback and consistent use of affiliation agreements Timely and specific feedback and information sharing to committees and staff. Hiring qualified staffDevelop process whereby partner organizations are regularly informed of project activities, challenges, and processes Establishment of a problem-solving process Transparent decision-making processes and resource allocation Shared leadershipEstablishment of working agreements

Key Areas of Focus 1.Establish a sustainability committee 2.Develop a process whereby parent organizations are regularly informed of project activities, (challenges*) & processes 3.Hire qualified staff Collaboration

Synergy “You think because you understand one you must understand two, because one and one makes two. But you must also understand and” (Donella Meadows, 1982) Collaboration

Synergy Grow Along with Me Launch 6 month ASQ Newsletter – Hanen Linkage with U of L –Dr. Kolb; nursing students Children’s Mental Health plan – ASQ-SE Primary Care Initiative Early Development Instrument Vision 2020: The Future of Health Care in Alberta: Phase 1. December Collaboration

Summary

Key Messages Parents want information regarding how they can best support their child’s development Collaboration is key to success Measurement, evaluation and ongoing improvement is critical

Next Steps End date Evaluation Sustainability

Taking the time to Grow Along With Me has the power to change a community!