1. Who are we reaching? Social demographics, health and social risk, services What are motivations and barriers related to call / screening? Reason for call, concerns about child, previous consultations What are the findings from screenings? PEDS and MCHAT results (What does this stand for) What are the services provided to low and high-risk children and families? Referrals, parent guidance, annual (re)screenings, care coordination, follow up, intensity of service) What is the impact? Screening outcomes – PEDS/MCHAT confirmed, diagnoses, Connections to programs and services What did the Evaluation Measure?

2. What are the Key Findings?

3. 1.Identification and Screening 2.Intervention Guidance Referrals to programs and services Care coordination 3.Follow up Connection to services Outcomes for children with positive screens 4.System Improvement/Transition to sustainability Partnership development Dissemination 5.Data Support Measures and data collection Systems Analysis What are the Key Components?

4. Sept 2009 – March 2010 Data in 4 separate systems. No standard unique ID. MS Access Form. Paper files April 2010 – October 2011 Development of measures. Cyclic quality improvement - program and data. April 2011 – November 2011 211 LinQ Care Coordination module. Automated processes and functionality Integrated with 211 LinQ IT Team Coming soon - May 2012 Model for expansion and integration Data and System Evolution

5. Who are we Reaching? “In-reach” targets children 0-5 among larger pool of 500,000 callers annually. 28% have children 0-5 years at home. 91% female 37% with only a high school education or less 65% Hispanic; 2 in 5 Spanish as primary language 25% African-American 20% uninsured (80% qualify for Medi-Cal) Half have low incomes (<1,000 /mo.) and half are unemployed Many utilizing public resources

6. Who is getting screened? Hispanic74% White5%Black15.4%

7. Children and families screened: Calling for assistance with basic needs 37% Female 95% Single-parents 50%. Children with health insurance 90.5% Children with Medi-Cal coverage 82% Children uninsured 7.4% One or two children 5 or younger 84% *Reasons are among all callers referred for developmental screening Who is getting screened?

8. Child development concerns 11.8% Early childhood education 11.3% Child care 8.1% Prior child development concern 28% Sought previous help 17% Sought help from a medical provider 15% Expressed concern more likely to screen at highest risk (Path A=37% and failed M-CHAT 38%). *Reasons are among all callers referred for developmental screening Reasons for Calling

9. 84,000 1 4,137 2 Offered Screening 10.9% 2,896 Interested70% accept offer Callers with children 0-5 1 211 LA annually 2 based on 10 month record review Who are we Reaching?

10. Screening Capacity in 2011

11. PEDS ResultNumberPercent National Standardization High Risk (Path A)94227%11% Moderate Risk (Path B)93427%26% Low Risk Behavioral Guidance (Path C) 63718%20% Low Risk (Path E)97228%43% Total3,485 PEDS Screening Results Two and one- half times the National Average

12. M-CHAT Screening September 2009 – October 2011 NumberPercent Fail38420% Pass1,57680% Total1,605 M-CHAT standardized study screened 4,797 children 466 Fail 9.7% Autism (M-CHAT) Screening For Children 16 to 48 months Data from September 2009 through March 26, 2012 Two Times National Average

13. Families who Consulted Medical Provider * Data from September 2009 through March 26, 2012 Medical Provider Actions: Risk: HighestModerateLow Provider Not Concerned61 21.1% 32 24.8% 8 24.2% Advised “Wait and See” / No Action 71 24.6% 32 24.8% 9 27.3% Provided Information21 7.3% 17 13.2% 12 36.4% Referral to Regional Center, School District, or CBA 83 28.7% 30 23.3% 4 12.1% Referral to Specialist53 18.3% 18 13.9% 2 6.1% Total Sought Medical Provider Assistance (*15% of screened) 28912933

14. Referrals and Care Coordination 4,606 referrals to different intervention programs 90.3% of children received a referral in one category 30.6% had referral in two categories. 25% of children were enrolled into one or more intervention services 30.6% were connected to referrals or had applications pending 38.6 % children low risk scheduled for annual re-screening What Services are Provided to Families?

15. Primary Referrals NumberPercent Head Start Preschool Program96230.7% Early Head Start Program70222.4% Early Childhood Education Program35011.2% School District –Special Education36011.5% Early Childhood Mental Health Program (Child Guidance) 1946.2% Regional Center (over 3 years of age) (Developmental Assessment) 1334.2% Early Start Program at Regional Center1534.9% Parenting Skills/Training481.5% Pediatric Well Baby/Child Follow-up591.9% LAUP Preschool (4 years of age)361.1% Hearing and Speech Evaluation401.3% Follow-up Developmental Screening922.9% Low Incidence referral to LACOE-EISS70.2% Program and Service Referrals

16. Primary Referral Categories Positive Autism Screening % Head Start Preschool Program 17.1 Early Head Start Program 7.0 Early Childhood Education Program 2.8 School District –Special Education 13.0 Early Childhood Mental Health Program (Child Guidance) 3.5 Early Start Program at Regional Center (0-36 months) 19.9 Regional Center (over 3 years of age) (Developmental Assessment) 33.9 Pediatric Well Baby/Child Follow-up 0.6 Hearing and Speech Evaluation 0.3 Program and Service Referrals for Children with a Positive Autism Screening Program and Service Referrals for Children with a Positive Autism Screening

17. Primary Referral Categories Positive Autism Screening % Head Start Preschool Program 17.1 Early Head Start Program 7.0 Early Childhood Education Program 2.8 School District –Special Education 13.0 Early Childhood Mental Health Program (Child Guidance) 3.5 Early Start Program at Regional Center (0-36 months) 19.9 Regional Center (over 3 years of age) (Developmental Assessment) 33.9 Pediatric Well Baby/Child Follow-up 0.6 Hearing and Speech Evaluation 0.3 Program and Service Referrals for Children with a Positive Autism Screening Program and Service Referrals for Children with a Positive Autism Screening

18. Outcomes to date for 3,485 children:NumberPercent Intervention Received – All Referrals2587.4% Intervention Received – One or More Referrals 61017.5% Connected to Recommended Referrals / Application for Service in Progress 106630.6% Low Risk-Scheduled for Annual Re- screening 134338.6% Unknown Outcome After Follow-up Conducted 2045.9% Impact of Care Coordination

19. Effectiveness of Care Coordination Outcomes to date for 3,485 children: Risk Level Accumulated to date for 3485 children: Highest % Moderate % Low % Intervention Received – All Referrals 13.112.81.0 Intervention Received – One or More Referrals 28.928.44.7 Connected to Recommended Referrals / App in Process 39.842.73.0 Low Risk-Scheduled for Annual Re-screening 1.91.689.7 Unknown Outcome After Follow- up Conducted 11.68.11.2

20. 211 LA Developmental Screening Partner Network Signed MOUs LA County Office of Education- Special Education Division LA County Office of Education- Head Start State Preschool Child Development Institute Comprehensive Autism Related Education, Inc. (CARE) El Nido Family Services -Early Head Start Program South Central Los Angeles Regional Center Children’s Institute, Inc. - Early Head Start and Head Start Program The Alliance for Children’s Rights-Early Steps Initiative Kedren Community Health Center - Early Head Start/Head Start and State Preschool Human Services Association –Early Head Start Program Montebello Unified School District – Head Start Program Eisner Pediatric & Family Medical Center MOUs in Progress Los Angeles County - Perinatal Mental Health Task Force USC –School of Early Childhood Education – Early Head Start and Head Start Program Training and Research Foundation Head Start Program Los Angeles County Public Health –Child Health and Disability Prevention Program (CHDP) Los Angeles County Public Health –Maternal, Child and Adolescent Health Programs Los Angeles County Office of Child Care- STEP for Excellence Program Magnolia Community Initiative

21. Health Communication Research Laboratory, Washington University in St. Louis, St. Louis Missouri –research collaboration with 2-1-1s across the USA to eliminate health disparities ZERO TO THREE - Policy Partner Help Me Grow – 211 LA is a member of the HMG California Learning Consortium Magnolia Place Community Initiative- Strengthening Families through the promotion of protective factors. 211 LA is a member of the Magnolia multi- system network and connects children that are screened and their parent/caregivers to the local initiative Los Angeles County Perinatal Mental Health Task Force - working on grant with 211 LA to conduct maternal depression screening Lucile Packard Foundation – 211 LA is a member of the California Collaborative for Children with Special Health Care Needs Collaborators

22. What proportion of callers with stated concerns vs. none accept screening offer and are screened? Currently a small proportion of parents have stated (or previous) concerns; is that changing over time? Opportunities to reduce missed opportunities among clients with stated concerns, e.g., increased warm transfers? How is the intensity of service changing over time as measured by the number of transactions required to connect families to services? What children and families require more assistance; how can in- reach be used to increase chances of finding them? Questions Going Forward?

23. What factors are related to outcomes; differences between risk factors or groups? What is best way to measure connections for low risk children? System and program improvements resulting from collaboration with 211 Developmental Screening Project? Opportunities for using technology and agreements to improve the exchange of outcome information and consent, e.g., telephonic signature, portals? Additional opportunities to link DSP with related efforts (national and local), e.g., research re: the value of screening, theory and practice re: family strengthening and protective factors, and expanded screening? Questions Going Forward?

24. Developmental Screening Call Mapping

25. Warm Transfer with Stated Concern Initial Call, Request for Service Community Resource Advisor Offers the Screening Warm Transfer to Care Coordinator