Early Childhood Developmental

Screening and Assessment in

North Dakota

Standards of Practice

2015

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Standards of Practice

Developmental Screening in ND

ND Goals for Screening 1. All ND children, ages 0-5, will receive developmental screening within recommended timeframes.

2. All ND children, ages 0-5, will receive age-appropriate and complete health and developmental screening

to identify potential health, social-emotional and developmental concerns in a family-friendly and culturally sensitive manner.

3. Children and their families who are referred through health and developmental screening will receive

appropriate and timely assessment, evaluation, and/or services to meet their identified need(s).

Developmental Screening – Three components 1. Observation – surveillance

a. Watch the child’s behavior, responses and interactions b. Parent discussion, concerns, health, etc. c. Health History d. Environmental settings (behaviors present in all?) e. Speech and Language f. Social skills g. Activity level h. Communication i. Relationships j. Problem Solving

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2. Screening The use of a standardized tool to identify a child at risk of a developmental delay or disorder

a. Identify and address problems early b. Caregiver reported (multiple sources if possible) c. Educate about developmental milestones d. Integrate as standard practice for all children e. Screening instruments are not diagnostic tools

i. Example – PTA volunteers screen for vision and hearing f. Identify children who need further evaluation

Screenings should identify: Physical Development o Growth issues o Vision and Hearing concerns o Oral Health concerns o Gross and Fine Motor Skills o Sensory Integration concerns

Behavior and Social-Emotional Concerns o Aggression o Anger o Attention difficulties o Excessive hyperactivity o Anxiety symptoms o Depressive symptoms o Relationship concerns

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Autism Spectrum Disorder Symptoms

Poor or avoidant eye contact

Lack of social smile and reciprocation

Social interaction concerns

Communication and speech concerns

Restricted, repetitive interests or behaviors

Arching back

Sensory sensitivity

Lack of empathy or understanding others feelings

Positive Screens

The screening score is outside normal limits, indicating potential need for intervention

Explain screening results with caregiver

Review and discuss any concerns identified

Do not label child based on screen - a screen is not a diagnostic tool

Refer child for further evaluation if indicated or requested

Complete appropriate agency forms for referral (ROI’s)

Inform caregivers of privacy rights

Identify and communicate wait times

Provide education on developmental milestones

Provide education and skills regarding typical concerns (bedtime, limit setting, etc.)

Follow-up with caregiver on referral

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Negative Screens The screening score is within normal limits

Explain screening results with caregiver

Review, address and discuss any concerns identified

Do not label child based on screen

Refer child for appropriate services, if indicated or requested

Inform caregivers of privacy rights

Complete appropriate agency forms for referral (ROI’s)

Identify and communicate wait times

Provide education on developmental milestones

Provide education and skills regarding typical concerns (bedtime, limit setting, etc.)

If a referral is made, communicate to caregivers about wait times, payment, etc.

Follow-up with caregiver

3. Assessment/Evaluation The process of identifying a delay or specific disorders impacting the child’s functioning

a. Standardized diagnostic tests and diagnostic assessment b. Completed by child therapists, child psychologists, child psychiatrists, neurologists, PT/OT, speech

and early intervention professionals c. If a disorder is identified, appropriate referral or treatment should be provided d. If disorder is not present, address symptoms through education or other appropriate referral

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When should children be screened? Pre-natal, if possible (in-utero impact)

o Trauma, domestic violence o Mother’s physical and mental health o Substance use o For pre-natal diagnosis

At Birth o Pediatrician, medical staff o In-home nurses o Post-partum screens

Age Intervals using Standardized Tests (minimum according to the AAP, 2006) o 9 months o 18 month o 24 months or 30 months

Developmental screens available from ages 1-66 months (depending on screen) o Typical screening intervals

6mo, 12mo, 18mo, 24mo, 36mo, 48mo and 60mo

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Table 1: Developmental Screening Instruments Instrument ASQ-3

Ages and Stages Questionnaires, 3rd Edition PEDS Parents’ Evaluation of Developmental Status

Type Parent Report Parent Report

Age Birth – 5 ½ years Birth through 7 years

Staff Required Para-professional scorer Para-professional scorer

Staff Time 2-3 minutes 2-5 minutes

Sensitivity 86.1% 75%

Specificity 85.6% 74%

Language English, Spanish, others English, Spanish, Vietnamese

Cost Contact publisher for cost information Contact publisher for cost information

Table 2: Social-Emotional Screening Instruments Instrument ASQ:SE

Ages and Stages Questionnaires: Social-Emotional

PSC Pediatric Symptom Checklist

Type Parent Report Parent Report

Age 3 months to 5 ½ years 4 to 18 years

Staff Required Para-professional scorer Para-professional scorer

Staff Time 1-5 minutes 2-12 minutes

Sensitivity 71 – 85% 88 – 92%

Specificity 90 – 98% 68 – 99%

Language English, Spanish English, Spanish, others

Cost Contact publisher for cost information Available at no cost

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Who should complete developmental screens? Parent, foster parent, guardian

Caregiver, teacher, childcare provider

Both parent and care provider

Ideally person taking screen should spend at least 15 hours per week with child

Screening can be completed with or without assistance

What settings should screenings be done? Home Settings (in-home services, Right Track, NFP, etc.)

Clinical Settings (therapy and medical care)

Early care and education settings

Ideally the best natural learning environment

Other o Early Intervention, Head Start, Child Protection, etc.

Strategies for Screening Implementation (see evaluation checklist)

Establish Screening Protocol

Train staff on early

childhood development and screening

Screen children at

determined intervals or if

a concern arises

Identify children at risk for

develeopmental delay

Provide feedback about

screen and address

concerns

Initiate referral process

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Establish Screening Protocol 1. What evidence-based screening tool is best for your agency? 2. Who will initiate screen? 3. Who will score the screen? 4. Who will address the screening scores and issues? 5. Who will make the referral if needed? 6. Who will bill and under what code? 7. Will your agency need a written consent form to complete the screen? 8. What referral options are there in your area?

Is there a wait time? Insurance? Sliding fee scale? In-home or In-office services?

Train staff on Early Childhood Development and Screening

1. Who will do the training? 2. Why is the screening important? 3. What common issues should staff be trained on that can be addressed by the administrator of the screen? 4. How will you introduce the screen to caregivers? 5. How do you talk about concerns identified within the screen or raised by caregivers 6. When should you refer? How do you talk to caregivers about referring?

Screen Children at Determined Intervals or if a Concern Arises

1. Identify suggested screening intervals of your chosen screen 2. Have you provided education about the screen to the caregiver? 3. Have you gotten guardian consent? 4. Is an interpreter wanted?

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5. Ask caregivers at each visit if they have any concerns 6. Provide assistance if needed or requested to caregivers completing screen 7. Referral process

Identify Children at Risk for Developmental Delays or Disorders

1. Score screen and discuss any concerns with caregiver 2. Continuously observe and screen at recommended intervals

Provide Feedback and Address Concerns

1. Review screening with caregiver 2. Educate on developmental milestones 3. Discuss concerns that arise from the screen 4. Address concerns that arise, whether the screen is positive or negative, through education, strategies and

activities 5. Provide education on formal and informal supports, the process, options and their rights

Initiate Referral Process

1. Inform family why you feel a referral is recommended 2. Inform family of options for referral 3. Provide information to families on privacy rights 4. Complete needed referral paperwork and ROI’s 5. Communicate with family about payment options and wait times 6. Follow-up with family

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Process for Increasing Screening in ND (while trying to avoid duplication)

Other Suggested Strategies 1. Identify and choose screens that are available in the languages of the population your most

frequently serve 2. Include screening training/protocol into orientation or job training and job description 3. Assure all staff are trained on the importance of screening and the screening tool 4. Develop relationships with those serving young children and families such as:

a. Child care programs b. Early education programs c. Special education d. Clinics e. Cultural communities f. In-home visitation services

5. Provide coordination and outreach to community providers to identify who is screening and appropriate referral sources for families and children

Identifty those working with

children, ages, 0-5, and their caregivers

Providers ask families if their child has had

a developmental screen in the past 6

months

If yes, obtain ROI to receive screen,

if caregiver agrees

If, no, or if there are new concerns,

educate about and complete the

appropriate screening

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6. Utilize or develop a resource guide for your service area 7. Educate staff about privacy rights and appropriate referral procedures for working with families 8. Collaborate and communicate with families and providers working with families to avoid duplication of

screening and services 9. Provide education and resources for professionals to give to caregivers and families on appropriate

developmental milestones 10. Identify issues commonly identified within screens and provide training to providers and identify resources

to teach and give to families (sleep, tantrums, etc.) 11. Keep records for tracking trends and future policy implications

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References Bright Futures: Social and Emotional Development Tools http://www.brightfutures.org/ Center for Disease Control and Prevention http://www.cdc.gov/ncbddd/childdevelopment/screening.html Center on the Developing Child, Harvard University http://developingchild.harvard.edu/

Child Health and Developmental Screening, MN Quality Indicators, 2004. A Comprehensive Framework to Build

and Evaluate Community Based Screening Systems

Danielson, Ramona, MPH Program at NDSU, 2014. Developmental Screening and Referral System in ND

Developmental Screening and Surveillance of Infants and Young Children, American Academy of Pediatrics

http://pediatrics.aappublications.org/cntent/108/1/192.full

Minnesota Department of Health, 2014o. Instruments at a Glace for MN Clinics and Providers

Squires, Bricker and Twombly, 2003. Brooks Publishing The ASQ: SE User’s Guide

This document’s development was funded by the North Dakota Early Childhood Comprehensive Systems grant.

For more information, please contact Mylinda Ogundipe, Program Director, at myogundipe@pcand.org; or Shawna Croaker, ND ECCS Contractor, at

rvcmhc@rvcscc.org.

http://www.brightfutures.org/http://www.cdc.gov/ncbddd/childdevelopment/screening.htmlhttp://developingchild.harvard.edu/http://pediatrics.aappublications.org/content/108/1/192.fullmailto:myogundipe@pcand.orgmailto:rvcmhc@rvcscc.org