1. Vermont’s Universal Developmental Screening Registry: Increasing Multidisciplinary Communication and Collaboration to Improve Child and Family Health
Our goal in Vermont is to have comprehensive, universal, developmental screening and improved school readiness for all young children. In an effort to narrow the gap and identify needs earlier in children, the UDS registry was created as an addition to the public health information system used for the immunization registry for Vermonters, as a means of sharing screening data across community settings and the health, education, and family support sectors.
Janet Kilburn, Child Development Coordinator
Janet Fortune, Health Data Administrator
Vermont Department of Health

2. Objectives
History and importance of efforts to improve Vermont’s system of universal, early and continuous developmental surveillance and screening
VDH Developmental Screening Registry pilot
Learn about the new Universal Developmental Screening (UDS) Registry and how it can benefit you and your practice or program
Discover how become an early adopter of our UDS Registry and a local champion for the Help Me Grow system
Our objectives, for this brief presentation, are to share a brief history of Vermont’s efforts to improve and ensure universal early and continuous developmental surveillance and screening, share how use of this Registry will support you and your program – whether you are an early educator or preschool teacher, home visitor, or child care provider. We want you to become an early adopter of our universal developmental screening registry and a local champion for our Help Me Grow system!

3. History: Vermont’s System for Universal Developmental Screening
2006: AAP Policy Statement
2009 – 2011: 1st VCHIP UDS improvement project
2013: Stakeholder engagement to develop shared vision, common definitions, framework and process map
2014: VCHIP began working with early care education/child care programs to implement Vermont’s System for Universal Developmental Screening
2014 – 2016: Accountable Care Organization (ACO) adoption of developmental screening as quality measure
2015: Help Me Grow Vermont implemented
2016 – 2017: Pilot test the UDS Registry; Provide TA; gather feedback
Vermont has a strong history of promoting developmental surveillance and screening. Following the American Academy of Pediatrics release in 2006 of a policy statement that provided guidance on developmental surveillance and screening, Vermont provided quality improvement training in developmental screening, beginning in medical home settings. This training has expanded today to include child care providers. Accountable care organizations have adopted developmental screening as a quality measure. In 2015, Help Me Grow Vermont was implemented. And most recently, the first pilot test sites were established for the registry in Lamoille and Orange counties with users including health care providers, early educators and Children’s Integrated Services providers. We continue to provide technical assistance and gather feedback.

4. AAP Developmental Screening Guidelines
Developmental surveillance at every well-child preventive care visit
Promptly address concerns with standardized developmental screening tests
New 4th edition revised recommendation: observation by child care and early childhood professionals be incorporated by the pediatrician into surveillance
Developmental Screening tests administered at the 9-, 18-, and 30-month visits
30-month screen can be done at the 24-month visit
Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics 2006; 118;405
Vermont has a strong history of promoting developmental surveillance and screening. Following the American Academy of Pediatrics release in 2006 of a policy statement that provided guidance on developmental surveillance and screening, Vermont provided quality improvement training in developmental screening, beginning in medical home settings. This training has expanded today to include child care providers. Accountable care organizations have adopted developmental screening as a quality measure. In 2015, Help Me Grow Vermont was implemented. And most recently, the first pilot test sites were established for the registry in Lamoille and Orange counties with users including health care providers, early educators and Children’s Integrated Services providers. We continue to provide technical assistance and gather feedback.

5. What would it take to ensure that all of Vermont’s children receive ongoing monitoring of their developmental progression?
25% of Vermont children who received health services in 2014 received all three recommended developmental screens by age 3*
7 out of 10 Vermont children have one or more factors that put them at risk for a developmental delay*
What would it take to get all children monitored and screened?
Despite all the work that has occurred in Vermont over the past decade to ensure developmental surveillance and screening occur in medical home settings, screening rates remain low – lower than the national average - and children with developmental concerns continue to show up in Kindergarten not ready to learn - let alone succeed! Early detection and connection to services lead to the best outcomes for children with developmental or behavioral concerns. However, many children with developmental delays are not identified as early as possible. In addition, many children have delays in language or other areas that can affect school readiness. Nationally, 1 in 6 children has a developmental disability AND 1 in 4 children experiences a developmental, behavioral, or social delay. In Vermont, 7 out of 10 children are at risk for developmental delay.
*CHAMP Network Data Summary Report: 2015 Findings. Vermont Child Health Improvement Program (VCHIP), University
of Vermont, College of Medicine. (Children’s Health Advances Measured in Practice)
*Barry, SE, et.al. (2012). Final Report: Developmental and Autism Screening in Primary Care. Vermont Child Health
Improvement Program [VCHIP]. University of Vermont, College of Medicine.

6. Community Agencies & Organizations
Vermont’s System for Universal Developmental Screening (Birth – 8 Years)
Vermont’s system for universal developmental screening is a collaborative process to understand every child’s developmental
progression and respond appropriately to meet each child’s developmental needs
Medical Home
Anticipatory Guidance
Surveillance
Screening
Referral for Evaluation
Care Coordination
UDS Registry
Help Me Grow Vermont
Data System
Help Me Grow Vermont
UDS Registry
Community
Communication
Child and Family
Surveillance
Screening
Self Referral (CIS, medical home, or other intervention services)
Care Coordination
Early Care & Education
Parenting Education & Anticipatory Guidance
Surveillance
Screening
Referral (CIS, medical home, or other intervention services)
School
Parenting Education
Surveillance
Screening (risk-based)
Evaluation
Referral (CIS, medical home, or other intervention services)
Care Coordination
Community
Collaboration
Data System
Vermont has developed a framework and policy recommendations for a statewide, comprehensive Universal Developmental Screening (UDS) System. The child and family are at the center of this framework that requires cross sector participation and collaboration across medical providers, schools, community service providers, child care providers and early educators. Our Registry provides the comprehensive data system for this framework.
UDS Registry
Community Agencies & Organizations
2013, Developed by the Vermont Child Health Improvement Program (VCHIP) in collaboration with: American Academy of Pediatrics- VT Chapter, Building Bright Futures, Child Care Resource, Children’s Integrated Services, Early Care and Education Professionals, Families, Howard Center, LUND, Northern Lights Career Development Center, Vermont Academy of Family Physicians, Vermont Association for the Education of Young Children, Vermont Agency of Human Services, Vermont Family Network, and Visiting Nurses Association
Family Support
Parenting Education
Home Visiting Services
Care Coordination
Screening
Consultation
Evaluation
Intervention Services
Building Bright Futures Regional Councils

7. Universal Developmental Screening Registry
All the while we have been building a registry….
Immunization, lead, newborn screening, hearing screening and now developmental screening
Core Component of Help Me Grow Vermont
System for UDS being implemented across multiple settings
There is no wrong door for developmental screening!
Registry is the venue for sharing information across various settings
With help from key stakeholders, we have built a dev screening Registry in an effort to advance developmental promotion, early identification and timely linkage to services. Use of this registry will support improved screening rates and help to identify young children with developmental concerns as early as possible.

8. Shared Public Health Information Exchange
What is SPHINX?
It is Vermont’s
Shared Public Health Information Exchange
It is a person centered database that supports applications that serve multiple VDH programs
For those of you that are not familiar with SPHINX, SPHINX is a shared public health information exchange system. It is also known as the Vermont Immunization registry. This registry includes all immunizations, hearing screenings, blood lead screenings and Newborn blood spot screenings. Data within SPHINX is only accessible via a secure permissions level entry point.

9. Patient Profile Immunization Registry Childhood Hearing Screening
A single web based application that includes
Immunization Registry
Childhood Hearing Screening
Blood Lead Levels
NENSP (Bloodspot) Metabolic Screening
Developmental Screening
Vaccine Inventory (currently in development)
Shared demographic data including primary care provider
Access is granted to users by specific program area and feature
Access to the online registry requires pre-approved user access.

10. Patient Profile: Developmental Screening
Screening Results of the ASQ3, ASQ-SE (ASQ-SE:2 will be available in mid June 2017) and MCHAT can be entered by providers who conduct screenings
Results for any one person may be viewed by users with view level permissions regardless of the child’s medical home or provider who entered the screening results.
Users with appropriate permissions can run reports including
Screening History – all screenings results recorded for a specific child
Due for Screening – lists children in a primary care practice who are due or past due for a screening per the per AAP/Bright Futures periodicity schedule
Follow-Up Report – lists children in a primary care practice in need of follow-up screening or referral
Activity Report – Measures a practice’s rate of screening the children associated with their by age group and screening tool over a given period of time per AAP/Bright Futures periodicity schedule
Contact person is Janet Fortune:
Using a high quality developmental screening tool like the Ages and Stages questionnaires, professionals conduct screenings to identify children who are at risk for developmental delay or other behavioral disorders in an accurate and cost-effective manner. Screening results of the ASQ3, ASQ-SE:2 and MCHAT can be entered by providers who conduct screenings. Results for any child may be viewed by users with view level permissions regardless of the child’s medical home or provider who entered the screening results. With appropriate permissions, educators, community providers and others can run a screening history report (highlighted in yellow on this slide). Medical home providers can run additional reports useful to improving screening rates in their practice. Remember not everyone has the permission levels to run reports.

11. Access Based Upon Permissions
Example = Developmental Screening User
with permission to…
View developmental screening data of any person
Enter Screening results
Edit or Delete Screening results entered by users from their practice
Print report of individual child’s screening history
Print practice level reports for their practice (medical providers)
Developmental screening users, depending on permission levels, can view developmental screening data for any child. They can enter screening results, edit or delete screening results entered by users from their program, school or agency (or practice). Educators and community providers can print reports of individual patient’s history.

12. Note: Only includes Patient Profile program areas to which user has permission.
Here is a brief overview of the registry and actual screenshot - you will notice under the Programs section on the left side of the screen developmental screening will appear.

13. Note: Only includes Patient Profile program areas to which user has permission.
You will continue to view the patient profile page once a child has been selected.

14. Once you have chosen the developmental screening tab you will be viewing UDS history for this child. Not all children will have history in the application. Once screening data is entered by a provider, other providers with appropriate view level permissions, will be able to view a child’s screening history and click on the detail of the individual screening tool. This is how use of the Registry allows providers to communicate screening results across settings.
Note: Only includes features within the program area that the user has permission to use.

15. Here is a view of the ASQ A short summary of total scores and score interpretation is required along with referral recommendations.

16. A look at the MCHAT reporting screen

17. A look at the ASQ-SE we have worked towards making this application a user-friendly environment.

18. Maternal & Child Health Director Vermont Department of Health
Please be in touch….
Breena Holmes, MD
Janet Kilburn
Janet Fortune
Breena Holmes, MD
Maternal & Child Health Director
Vermont Department of Health
Thank you for viewing the presentation into the Universal Developmental Screening registry, if you feel you are ready to join our every growing community of screening reporting providers, please contact us and we can get you started in a collaborating effort on reporting Universal Developmental screenings. Thank you and we hope to hear from you soon.