1. CHLA Provider Training
CENTERS FOR DISEASE CONTROL AND PREVENTION’S “Learn the Signs. Act Early.”
CHLA Provider Training
Fran Goldfarb, Danny Azucar, Bozena Barton, and Rachel Marshall
February 16, 2015
Danny

2. Pre-Training Surveys
We appreciate your time and your feedback!

3. Presentation Objectives
Discuss the “Learn the Signs. Act Early.” campaign and materials
Review the AAP Guidelines and California screening statistics.
Identify barriers and solutions to providing anticipatory guidance
Review local resources for early intervention.
Danny

4. LTSAE: Background A CDC Campaign Development Transtheoretical Model
Marketing Mix (4 P’s)
Target Populations
Parents
Health Professionals
Early Educators
Danny
The CDC reports that 17% of children under the age of 18 in the USA will have a developmental disability. These disorders/disabilities can be diagnosed as early as 18 months of age and will continue through the persons lifetime.
In 2004 the CDC launched a research based campaign, LTSAE, aimed at increasing action amongst parents, healthcare professionals and early child educators.
CDC used the Trans-Theoretical Model in guiding the development of this campaign, as well as social marketing principles to segment the target audience into three.

5. Let’s talk about
Your essential, irreplaceable role in developmental monitoring and early identification
FREE resources to make discussing screening and development with parents easier
Danny
I’ll discuss the importance of your role in developmental monitoring and screening and why early identification of developmental delay is so important, I’ll introduce resources that will make talking with parents about typical development and developmental concerns an easy part of every well-child visit.

6. AAP Developmental Surveillance Guidelines
Surveillance at every Well Child visit should include:
asking about parents' concerns
obtaining a developmental history
making observations of the child
identifying risk and protective factors
documenting the findings
The AAP recommends developmental surveillance
--the process of recognizing children who might be at risk for developmental delays—
in addition to using standardized tools to administer a developmental screening at Every Well child visit
Set the foundation for parental involvement and education in the process of tracking developmental milestones

7. AAP Developmental Screening Guidelines
The AAP recommends standardized developmental screening at well-child visits
All children screened to assess their general development at 9,18 & 24 or 30 months
All children screened for ASD at 18 & 24 months
9-Month-Old Child
18-Month-Old Child
Take home message is that you don’t have to be concerned in order to screen- it should be routine part of every well-child visit
ALL children should receive thorough developmental screening- not just kids at risk.
Parents appreciate the screening process and being a participant in that process- the comfort is provides when their child is developing as expected or the
affirmation it provides when they have concerns regarding development
24-Month-Old Child

8. Screening Statistics 1 in 6 children has a developmental disability
12-16% U.S. children have a developmental or behavioral disorder 1
Prompt identification can spur specific and appropriate therapeutic early interventions2
Fewer than 30% are identified by clinician judgment alone before entering school3
Developmental monitoring and routine screening help you identify delays as early as possible,
so you can refer the child to BOTH a specialist who can further evaluate the child and explore potential diagnoses
AND the early intervention or special education programs that can help a child reach his or her full potential.
AAP Policy Statement, Pediatrics 2001
AAPA Policy Statement, Pediatrics 2006
Sand, et al. Pediatricians’ reported practices regarding pediatric screening. Do guidelines work? Pediatrics 2005

9. Barriers to Screening
What are YOUR barriers?
Bozena

10. Reported Barriers to Conducting Standardized Developmental Screening for Children 0-3 Years of Age
Proportion of Pediatricians Reporting as Barrier to Screening,
Time limitations in current practice
89%
Lack of medical office staff to perform screening
49%
Inadequate barriers (ie, physician or staff members cannot speak language of family)
46%
Lack of confidence in ability to screen
19%
Lack of treatment options for positive screening results
10%
Lack of knowledge regarding referral options for positive screening results 9%
Survey
This data came from a research article from Pediatrics that surveyed health care practitioners to identify their barriers to screening—
Responses came primarily from pediatricians
Only 23% reported that they used a standardized screening instrument and as we saw from the earlier slide- fewer than 30% of children are id’d by clinician judgment alone before entering school
Only top 2
Acknowledge that some items were not reported in survey as potential barriers- but were mentioned by group as concerns– we can address these later!
Lack of insurance reimbursement – by making parents more involved in screening, and coming to well child visits with materials in hand it will take far less time to perform screenings and result in shorter visits
Sand, et al. Pediatricians’ reported practices regarding pediatric screening. Do guidelines work? Pediatrics 2005

11. LTSAE Materials
Developed by CDC, in conjunction with the AAP
Objective, research- based
Make visits more productive and more time-efficient
Empower parents to become better partners in tracking development
Rachel
Meant to be a 2 pronged approach: 1. Anticipatory guidance/discussion and 2. Standardized screening at prescribed intervals.
Developed by CDC and AAP, based on evidence of development.
not a replacement for the standardized developmental screening you conduct
Parents can base their observations on objective, research-based, age-appropriate developmental milestones.
Realistic expectations about their child’s development
Providers spend less time calming unnecessarily worried parents
More time discussing real areas of concern
If you have other materials, use these to fill gaps
Use parent-friendly language, sensitive to education and literacy
Have been tested and are well-received by families

12. LTSAE Materials Completely free
Can be ordered online and mailed to your office for free.
Some resources are printable online.
Rachel

13. LTSAE Materials Designed for use by: Parents Books, growth chart
Professionals
How to discuss milestones
Tip sheets
Parents and Professionals Together
Tracking tools
Rachel
(Pass out the LTSAE Materials during presentation)
Celebrate typical development
Each material targeted for various use
Some promote campaign- tracking more than just development
Some give families tools to track their child’s development
Others audience professional, such as tips on how to talk to families

14. Campaign Posters Appropriate for: Waiting room Office wall
“It’s time to change how we view a child’s growth.”
Rachel
campaign focus
If you need some art in your waiting room

15. Milestones Brochure Waiting room
Select milestones at a glance for ages 6 months to 4 years
Rachel
Get them thinking about milestones before they even walk into the visit.
Audience: parents
introduction to monitoring developmental milestones
Key milestones
What to do if concerned
Inviting design, low literacy friendly parent friendly
Parents as a partner
Prepare them for routine screening
Good brochure for waiting area and/or exam room
English and Spanish available
Order or download, print, and customize

16. Milestone Moments Booklet
Rachel
All 10 checklists

17. Milestone Moments Booklet
Free and customizable
Can be ordered on the website
Helps parents prepare for well- child visits
Milestone checklists
2 months – 5 years
Four domains of development
Developmental “red flags”
Activities to foster development
Rachel
comprehensive, full milestone checklists for all domains of early development
2 months through 5 years
matches the recommended ages for well-child visits
Age-appropriate activities that a parent can use to engage child
Place for parents to record questions or concerns
Free in limited quantities - go to website
Spanish
Customizable- add your practice logo, contact information for local early intervention resources
Print as many as you want
Audience:
every newborn visit
all new families in your practice
Encourage parents to bring it to each well-child visit.

18. Milestone Checklists
Free and printable onlinehttp:// arly/downloads.html#checklists
Well Child Visits
A checklist to be given at each corresponding well child visit
2 months through 5 years
Same information as milestone booklets
Parent tested
Spanish translation on reverse
Rachel
Same info as moments booklets, but just for each well child visit age.
Go to website to show how to print
Sample checklist
Four domains of development
Red flags
2 months through 5 years
Give at every corresponding well-child visit
Printed from CDC’s “Learn the Signs. Act Early.” website
Parent tested

19. Story Time Celebrates typical development Age-appropriate activities
Currently developing books for 1 and 2 year olds
Rachel

20. Growth Charts fg
Select milestones at a glance for ages 1 month to 5 years
English and Spanish on reverse
Rachel

21. Inglés y Español Additional languages: Arabic Korean Portuguese Somali
*some materials
Rachel
all materials in Spanish and English
some in other languages
CDC welcomes additional translation

22. “Failed” Screening
What if a Child Fails the
Developmental Screening?

23. Explaining the “Failed” Screening
Prepare Parents
Normalize the discussion about developmental milestones
Empower parents as participants in the screening process
Bozena
By normalizing the discussion it will better prepare parents to observe their own child’s development in daily settings and will make the process much less frightening and out of the blue
a. Talk about milestones at each visit, starting at 2 months
Parents as participants in developmental milestone tracking
b They can become accustomed to track milestones in daily settings from birth
c They become more aware of and educated about typical patterns of growth and development

24. Explaining the “Failed” Screening
Remember Purpose of Screening
Use language consistent with the child’s need for more comprehensive assessment
Bozena
Purpose of screening
a. Screening does not diagnose developmental disorders
b. Life course model: use screening as a Protective Factor to
enhance Functional capacity over the child’s life course
Use language consistent with child’s needs
c. Phrases like the following can be used:
“may be delayed,”
“ this suggests…,”
“may be having difficulties compared to other children his age,”
“may be behind other kids,” “seems to be learning more slowly,”
“could be having difficulty learning.”

25. Explaining the “Failed” Screening
Provide referral telephone numbers and descriptions of services
Identify social worker to help families who are likely to have multiple barriers to following through with recommendations
Bozena
Referrals:
a. Descriptions of programs enable families to visualize what participation will look like and increase the chance they actually will participate
Social Worker for families in need:
a.. Bring in the social workers from the unit for families who have a lot on their plate- they can offer recommendations
b. For example, single parents with low incomes and multiple life stressors

26. Explaining the “Failed” Screening fg
Follow carefully those children who fail screens but do not qualify for services
Lets celebrate when children pass screening & offer reassurance that learning and development appear to be coming along well
Bozena
a. Referrals to services for children at risk, such as Head Start, quality child care, after-school tutoring, and summer programs
AAP Section on Developmental and Behavioral Pediatrics Newsletter, Fall 2007

27. Early Intervention Resources fg
Regional Center Services – Early Start
7 Regional Centers in LA County
21 Regional Centers in California
Children 0-3 IDEA Part C
Evaluation
Intervention
Family-centered,
Natural environments
No referral necessary
No existing diagnosis necessary
Rachel
The logical next step if a child does not pass a screening . Always better to make the referral than not. If in doubt, make the referral.
, EI eligibility changing (for the better!)
Do you know the regional centers in this area?
Lanterman
Westside
South Los Angeles
East LA
Harbor
North Los Angeles County
San Gabriel/ Pomona

28. Family Resource Centers
Early Start Family Resource Centers
Within and outside regional centers
CHLA Family Resource Center 93/k.98C2/Family_Resource_Center__Patient_H ealth_Education__Program_Support.htm#.VNpA XV47ZhI
Rachel
Resource Centers
Provide handout regarding Early Start family Resource Centers in LA
Families who have been turned away
ASD benefits, such as behavioral therapy
Physical disabilities: CCS
Children over 3

29. Additional Resources Medical Insurance Benefits
California Children’s Services (CCS)
Children older than 3
Special Education
IDEA Part B
Regional Center
Eligibility: ASD, CP, ID, or Epilepsy
Rachel
Resource Centers
Families who have been turned away
ASD benefits, such as behavioral therapy
Physical disabilities: CCS
Children over 3

30. Free Continuing Education
Free online courses eligible for CME, CNE and CEU credits
MOC (Part 2) Approved
Identifying
Diagnosing
Managing
In-Class Curriculum
Teaching Guide
Video Library
Rachel
Free!!
Credited 20 points toward Maintenance of Certification Part 2 through the American Board of Pediatrics. CE Credits Maintenance of Certification Part 2 requirements.
LTSAE: broad context, focus on typical development
All health care providers: ASD due to prevalence (1 in 88)
If you don’t already have patients with ASD, chances are you will in the future.

31. Autism Case Training Early Warning Signs Screening
Communicating Concerns
Making an ASD Diagnosis
Early Intervention and Education
Treatments for ASD
ASD-Specific Anticipatory Guidance
Rachel
Videos of Children
Topics: Early Warning Signs, Screening, Communicating Concerns, Making an ASD Diagnosis, Early Intervention and Education, Treatments for ASD, ASD-Specific Anticipatory Guidance
Downloadable curriculum available at no charge
 Handouts
powerPoint slides
video library

32. LTSAE Website http://www.cd c.gov/ncbddd /actearly/inde x.html
Show checklists, Autism Case based training

33. Discussion “It is time to change the way we view a child’s growth”
“A 4 year old with Autism, was once a 3 year old with autism, was once a…”
“Everyday you see them reach milestones, this CD will you spot a few more”
Danny
Past research on LTSAE indicated that fear-based messages that focused on the severity of autism and the need to identify the signs of autism early quickly turned parents away.11 Instead, messages that focused on the natural and strong desire to monitor a child’s physical growth and development positively engaged parents and provided an opportunity to educate them on the full range of developmental milestones.

34. Post-Training Surveys
We appreciate your time and your feedback!