Screen for Success: EI-WIC Developmental Screening Collaborative

State: NY Type: Model Practice Year: 2013

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Pediatric research strongly suggests the existence of disparities in recognition and treatment of developmental delays in children (Flores, 2010). In order to increase early identification of developmental delays and treatment in at risk communities, the Nassau County Department of Health (NCDOH) leveraged the resources of their two major Maternal Child Health programs; the Early Intervention Program /Child Find (EIP/CF) and WIC. Screen for Success: EI-WIC Developmental Screening Collaborative at WIC sites provides access to education and developmental screenings for the target population of children under age three of low socio economic status (SES). When appropriate, they are directly referred into EIP for tracking or complete evaluations and services.

 

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Nassau County Department of Health
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Screen for Success: EI-WIC Developmental Screening Collaborative
Pediatric research strongly suggests the existence of disparities in recognition and treatment of developmental delays in children (Flores, 2010). In order to increase early identification of developmental delays and treatment in at risk communities, the Nassau County Department of Health (NCDOH) leveraged the resources of their two major Maternal Child Health programs; the Early Intervention Program /Child Find (EIP/CF) and WIC. Screen for Success: EI-WIC Developmental Screening Collaborative at WIC sites provides access to education and developmental screenings for the target population of children under age three of low socio economic status (SES). When appropriate, they are directly referred into EIP for tracking or complete evaluations and services. Nassau County, New York has a population of 1,350,000, making it the 27th largest county in the nation. The County is undergoing a rapid demographic shift; it is aging and it is becoming far more ethnically, racially and economically diverse. Although there are pockets of great prosperity in Nassau County, areas of extreme poverty abound, and subsequent health disparities are a major concern. NCDOH is a full service health department and includes several programs specifically targeting at-risk populations. Each year, the Office of Children with Special Needs Early Intervention Program has contact with approximately 6,000 children; provides developmental evaluations for over 4,000 children and has an active caseload of approximately 3,000 children ages birth to three. Each year the WIC program distributes $14 million dollars in food vouchers to over 13,000 Nassau County residents of whom, 63% are Hispanic, 24% African American, and 13 % classified as other. The WIC site in Hempstead, NY was selected for both its demographic profile and with an average of 5000 clients per quarter, is the most active WIC site. Since its inception in April 2011, 334 children at WIC have been screened using the Ages and Stages Questionnaire -3 (ASQ-3). This instrument was selected for its reliability, ease of administration, and availability in English and Spanish. Its use is supported by the American Academy of Pediatrics (AAP). The overall objectives of Screen for Success are; to foster parents’ awareness of child development, increase opportunities for developmental screening, and facilitate the delivery of early intervention services to WIC families. Using a collaborative model with the WIC program, screenings are offered on site to children birth to three. This program creates a seamless system for referral and enrollment in the early intervention program. Opportunities exist to provide parent education and information about developmental milestones and activities to promote development even if parents do not choose to have their child screened. Sharing the common goal of addressing health care disparities and accessing early health interventions among vulnerable populations was one of the main factors that lead to an effective collaboration between Early Intervention and WIC. The population that WIC serves lends itself to the exact clientele that Child Find has been making efforts to reach. WIC identified the sites and days with the highest volume, provided the space to be used for the screenings and storage of materials. A Public Health Nurse from Child Find is assigned two days per month to the WIC site to offer a developmental screening for children under the age of three. Parents who do not choose to have their children screened still benefit from increased awareness about the availability of early interventionservices and information about developmental milestones. The nurse screens an average of twelve children per day and provides educational outreach for parents who did not choose a screening. After reviewing results with the parent, children identified with a suspected developmental delay can be directly referred to EIP. The nurse explains the process, reviews evaluation options and addresses questions and concerns about the referral in an effort to eliminate some of the barriers that exist to full enrollment in EIP. The set up costs for the program were relatively minor and sustainability is anticipated as the staff, space and materials are already funded through the two programs. An ASQ-3 basic startup kit can be purchased for less than $1000.00 and handouts were purchased for approximately $500.00. The materials for set up include consent and EIP referral forms, the ASQ-3 screening tool kit, promotional giveaways and informational materials. The number of families educated, has been much higher than has been is experienced at traditional community outreach activities. Children screened at WIC appear to have a significantly higher incidence of developmental concern or delay. The LHD is in support of continuing this valuable practice.
Responsiveness The public health issue that this practice addressesResearch has documented health disparities in access to care for several subpopulations including those defined by minority ethnicity, low income, recent immigration and limited English proficiency (Shapiro and Derrington, 2004). A collaborative study with the CDC and Health Resources and Services Administration, Trends in the Prevalence of Developmental Disabilities in US Children, 1997-2008 reports that 13% of children in the United States have developmental disabilities (Boyle, Boulet, Schieve, Cohen, Blumberg, Yeargin-Allsopp, Visser and Kogan). The Early Intervention Program was created under Public Health Law based on early identification and action to promote more positive developmental outcomes in children birth to three. However, evidence suggests that early intervention enrollment falls substantially below the proportion of children in need (McManus, McCormick, Acevedo-Garcia, Ganz and Hauser-Cram, 2009). In 1960, when the US Census began to classify race, whites accounted for 96.7% of the Nassau’s population. By 2000, that percentage had decreased to 79.3%, with blacks accounting for 10.1% and Asians accounting for 4.7%. Individuals of Hispanic origin (of any race) accounted for 10.0% of the population. Twenty-three percent of Nassau’s population speaks a primary language other than English in the home. Greater poverty levels were associated with less EI participation. Hispanic and multi-cultural children were less likely to receive EI (McManus, 2009). According to the CDC study, children insured by Medicaid had a nearly two-fold higher prevalence of any developmental delays compared to those with private insurance. Children below the federal poverty level had an even higher prevalence of developmental delays (Boyle, Boulet). Families with consistent well care for their child are more likely to be informed of available services from their health care provider. Problems facing low SES families including lower health literacy rates, transient lifestyles, inconsistent health care, suspicion of government programs and lack of diagnosis, contribute to limiting their access to early intervention services. The Screen for Success initiative is directed at addressing this gap in access to care.Process used to determine the relevancy of the public health issue to the communityThrough their Community Health Assessment, Nassau County DOH is able to identify communities that are at increased risk for health problems. These became targeted areas of focus for public health activities. Individual programs were encouraged to review gaps in services and develop plans to address the inequities. The access to care issue related to the awareness and participation in early intervention services was a public health issue of concern to the Office of Children with Special Needs. There were several influences determining the relevancy of this public health issue to the community. A review of the literature supported anecdotal reports on the status of EI use that is seen in Nassau County. As with other health care services, early intervention services are underutilized by families whose socio economic status put their children at higher risk for developmental delays. A 2005 Northeast Regional Public Health Leadership Institute(NEPHLI) project, conducted by a Nassau County Public Health Nurse, explored WIC referrals to EIP. The findings strongly indicated that WIC children have reduced access to developmental screenings and that there is a need to develop changes in program design and process to enhance these referrals. A 2010 study on disparities reports that “racial/ethnic disparities in children’s health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care” (Flores, 2010). The NYS Bureau of Early Intervention encourages outreach to underserved communities and sends out periodic surveys to see how municipalities are capturing vulnerable populations such as ethnic minorities and low SES groups. The NCDOH experience, in their efforts to do outreach in other at risk community settings, did not successfully increase the identification of children to any significant degree. Providing developmental screenings and educational outreach at WIC sites has increased the number of families in this vulnerable population that are being engaged in early intervention. Screen for Success also provides improved staffing efficiencies in both WIC and Early Intervention by combining the structure, staff resources and clients of two programs within the Local LHD.How the practice addresses the issueIt is well documented that vulnerable children are often underserved. Screen for Success responds to this disparity. Families struggling to meet their most basic needs are less likely to have the time or resources to seek help for less immediate needs. Creating access to developmental screenings that coincides with obtaining WIC services reduces this barrier. Including the parent in the education and decision making process about their child’s developmental needs increases the parent’s investment in the process. Children and families are best served when screening efforts are coordinated with the child’s primary medical care. The AAP recommends that using a formal screening instrument such as the ASQ increases the recognition of suspected delay and can lead to better referrals over the use informal observation alone (AAP Council on Children with Disabilities, 2006). From April 2011 thru September 2012, 334 children received developmental screenings through Screen for Success. A total of 79 children were identified for referral. 42 of these children were enrolled in Child Find for developmental tracking due some “at-risk” factor(s) and 19 children were referred to Early Intervention for a complete multidisciplinary evaluation due to suspected developmental delay. The evaluation section of this application will further detail the outcomes of children screened. A tally of families participating in the educational outreach at WIC but who declined a screening for their child shows an average of 31 parents per session receive information and handouts on early intervention services, developmental milestones, and activities to foster their child’s development. This measure will serve to judge parent interest and make projections for needed materials. Screen for Success is clearly aligned with the CDC’s “Winnable Battle” of teen pregnancy. 414 (10%) pregnant women in the Nassau WIC program are teenagers. Children born to teenage mothers have been identified by the NYS EIP as an at risk group that warrant developmental monitoring. This practice has the opportunity to connect with young mothers early on to provide information on the developmental needs of their babies and engage them for ongoing developmental tracking. Innovation Evidence based strategies used in developing this practice"Evaluation of Factors that Influence Successful Introduction of WIC Families to the Early Intervention Program, 2005 NCDOH NEPHLI Project "The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN", McManus, McCormick, Acevedo-Garcia, Ganz, and Hauser-Cram,2009 "Racial and Ethnic Disparities in the Health and Health Care of Children", Flores and The Committee on Pediatric Research, 2012 "Trends in the Prevalence of Developmental Disabilities in US Children 1997-2008, Boyle, Boulet, Schieve, Cohen,Blumberg, Yeargin-Allsopp, Visser and Kogan "Engaging Families", National Academy for State Health Policy, www.nashp.org/engaging-familes This practice is new to the field of public health? Process used to determine that the practice is new to the field of public healthWe conducted a brief literature review to determine whether any other local health department (LHD) had incorporated screening of children for developmental delay into their WIC program as a strategy to increase access and reduce disparities in early intervention services. We found no evidence that other municipalities had implemented similar projects. In addition, we directly queried the 8 New York Metropolitan Area WIC Directors regarding the existence of developmental screening in the WIC site and believe that we are the first LHD to integrate these services.
Local Health Department and Community Collaboration Primary StakeholdersThe primary stakeholders in this initiative are the two programs in the Division of Community and Maternal Child Health; Women, Infant and Children (WIC), Early Intervention /Child Find Program (EIP/CF), children birth to three and the families that are served by both programs.LHD RoleThe Nassau County Health Department administers both the WIC and EI Programs. These programs are part of the Community, Maternal and Child Health Services Division which is the largest division within the health department. The WIC program has been operated by the Department since 1978. It has been the sole provider of WIC services in Nassau County until 2010 and currently has access to six thousand five hundred low income children from birth to age three (the target population). The WIC program provides services at five WIC sites all located in the zip codes identified by the New York State Department of health as high risk. The EI Program became part of the NCDOH in 1993 after state legislation mandated that the health department assume responsibility for administering the program. The Nassau County Department of Health’s mission is to promote and protect the health of the residents of Nassau County and to eliminate health inequality and promote healthy lifestyles for minority, ethnic, and racial groups. Screen for Success is based on these same principles and goals that naturally foster this innovative collaboration of conducting developmental screenings at the WIC site while participants receive nutrition education and food vouchers to enhance the health and well being of at risk families.Stakeholder/partnersBoth programs have always been strong advocates in empowering families to gain access to essential services that enhance the health and wellbeing of their children. The Directors of the EI and WIC Programs are both Scholars of the North East Regional Public Health Leadership Institute (NEPHLI) in Albany, NY. NEPHLI was a year-long experiential program whose goals were to build and improve the leadership skills of emerging public health leaders from local, state, allied public and private organizations to broaden their vision of public health policy, practice and collaboration and foster improved decision making within their organizations. NEPHLI afforded the director of the EI Program the opportunity to address a need and promote public health through a collaborative partnership between EI and WIC. The actual planning for a developmental screening and educational outreach at WIC began with a proposal to the Division of Community, Maternal and Child Health from Early Intervention/Child Find on using the client base at WIC to access the target population. The WIC program has extensive experience in partnering with community based agencies at their WIC sites including Food Stamp application and Health Insurance Facilitated Enrollment. The two programs negotiated the specific details on location, time and access. In an effort to gain staff support for Screen for Success both programs received training on the mission and day to day operations of each other’s other program. WIC provides the physical space, translation on a limited basis, identifies children under age three upon arrival, and encourages parents to participate in the education and screening. EIP/CF provides the materials, conducts the educational outreach, screenings, referrals, and follow up activities.The key stakeholders are under the direct supervision of the Director of Community, Maternal and Child Health Services and collaboration is ongoing. Each program has experienced public health nurses that have worked in both programs and are extremely knowledgeable regarding the demographics of the target population and the obstacles they face in regards to accessing services for their families. The Community Health Assessment (CHA) that is created by the Nassau County Health Department every five years informs the programs regarding various social indicators used to measure the health status of the county residents and identify local healthcare community resources. The CHA describes factors related to access to care, transportation, housing, barriers to care, legal, social, economic aspects, education, employment, media and communication. It also describes in detail the healthcare resources available in the County such as hospitals, physicians, community health centers etc. The information from the CHA, public health knowledge, experience of the NCDOH and the key stakeholders has laid a fertile foundation for this collaborative partnership that continues to prosper.Lessons learned1. Educating the staff of both programs about the objectives of Screen for Success, the responsibilities, functions, and value of each other’s program aided in overcoming some initial reluctance about the proposed program. 2. Client consent to share information between programs is important to ensure follow up with families who are lost to services along the continuum of care. Barriers: 1. Families frequently become lost to follow up during the Early Intervention assessment process and eligibility for Early Intervention is often not determined. 2. WIC staff had concerns about possible interference with the day to day operations of their primary function to serve all participants. 3. There was a need for bilingual Child Find staff and were not able to rely on WIC staff to meet the need. Implementation Strategy Tasks taken to achieve each goalThe first objective is to educate parents of children under age three about developmental milestones and the importance of monitoring growth and development as part of their child’s health. To achieve this objective, WIC staff and the Child Find nurse work cohesively to identify children under age three and encourage the parents to participate in the developmental education component either before or after they obtain their WIC services. Child Find compiled an inventory of educational handouts and giveaways. The second objective is to increase the number of children who obtain a developmental assessment for their child. No prior appointment is required for the screening. The educational component streams interested families into the developmental screening. The Ages and Stages Questionnaire – 3 was selected as the screening instrument. Its availability in Spanish has been essential as the population of Spanish only and limited English proficiency is much higher than the program design initially anticipated. Through prior experience and the questionnaire’s estimated 4- 6th grade reading level, it was expected that many parents would be able to complete the questionnaire on their own. This increases the number of children that can be screened per day in addition to the educational activities that are provided at each session. The nurse works with parents who require more assistance to complete the questionnaire. The results are scored and reviewed with each parent at that visit. The third objective is to reduce barriers to utilization of early intervention services for eligible children in the WIC program by providing enhanced case coordination (system navigation and health literacy). Screen for Success creates a seamless system of referral and enhanced follow up for children within the early intervention system. The type of follow up is indicated by the results of the screening and parent interview: 1. direct referral to EIP for multi-disciplinary evaluation due to suspected delay; 2. case opened to Child Find for ongoing tacking due to at risk criteria; 3. no delay or at risk criteria is identified and the child is referred to the primary care physician for regular well care and developmental surveillance. Time FrameThe issue of access to early intervention services and information for at risk communities has been identified as an ongoing area of need within the Office of Children with Special Needs (OCSN). The concept for Screen for Success began to formulate at the end of 2010. In early 2012, a proposal was presented to the division director of Community, Maternal and Child Health and the director of WIC. There was immediate support for the initiative. We were using staff and resources already available through the programs, so there was not much lead time required to implements the program. From this point, the time frame for implementation was only about two months. During the planning period, there was ongoing communication between the supervisor of Child Find and the director of WIC to work out the logistics and to set up a cross training in service for staff of both programs. Child Find compiled and organized the structure and required materials. Screen for Success was launched on April 1, 2011.Outline of steps takenEstablishing the program format involved; setting up the procedure, estimating the staff, man-hours, materials and detailing the costs. Forming a partnership between Early Intervention/Child Find and WIC was important in gaining approval to establish the program. Cross training staff to understand the mission and day to day operations of both programs was an integral part in gaining cooperation between EIP/CF and WIC staff. WIC identified the site with the highest volume of clients per day and provides the physical space to accommodate the educational and screening activities. Child Find compiled and maintains the necessary materials which include the Ages and Stages Questionnaire- 3 screening tool (ASQ-3) in English and Spanish, consents, educational handouts and giveaways. A Public Health Nurse from Child Find is assigned to WIC twice a month to conduct the developmental education and screening. The nurse has an informational table set up on site and an area to meet with parents. WIC staff encourages families, with children birth to three years, to participate in the program at their regularly scheduled WIC appointment. The Child Find Nurse engages parents and discusses development, offers educational materials and a developmental screening. Interested parents are given the age appropriate ASQ-3 to complete on their own or with assistance from the nurse, as needed. The nurse scores the ASQ-3, reviews the results, and discusses the recommendations with the parent. With parental consent, the case is opened to Child Find for children exhibiting at risk criteria, or to Early Intervention if a developmental delay is suspected. In cases where no concerns are identified, the nurse explains the importance of continuing regular pediatric well care to monitor health and development. The educational materials include: “Early Help Makes a Difference”, developmental milestone checklist, NYSDOH “Learn the Signs”, autism awareness, NYSDOH “Helping Parents Make a Difference”, program brochure, Office of Children with Special Needs Developmental activity cards; play based parent and child activities to foster developmental in 3-6 month age intervals, Denver Developmental Activities and Noodle Soup catalog Home safety checklist Long Island Early Childhood Direction Center brochureLessons learned 1. Need for bilingual CF staff 2. Value of targeting outreach to high need populations of children 3. Importance of all stakeholders being vested in the project WIC staff was unable to provide sufficient translation to meet the need of Spanish speaking families. Reaching out to other community partners has helped in this area. A bilingual teacher from the Long Island Early Childhood Direction Center, as member of the Local Early Intervention Coordinating Council Public Awareness Subcommittee, participates as a community partner to help meet this need. We are working to identify additional staff and or other community partners to fully meet this need. Naturally, as with most change, there were concerns on the part of WIC staff about the screenings interfering with their ability to complete their requirements. Having the staff meet together to understand each other’s program and system of operations addressed this problem. One of the local teaching hospitals was very interested in Screen for Success as placement for pediatric residents. This partnership brought to attention the need to connect our screening activity with the child’s primary medical home so we began obtaining parental consent to share the results of the screening with the pediatrician. This practice is aligned with the National Academy for State Health Policy’s “Assuring Better Child Health and Development" ABCD III initiative, promoting community health partnerships for developmental screening to improve developmental outcomes in children birth to three,www.nashp.org/care-coordination-and-linkages-to-services.Cost of ImplementationEstablishing the Screen for Success program is a natural opportunity to reach a target population of low SES infants and toddlers. The set up costs for the program were relatively minor and long term sustainability is expected as the staff, space and materials are already funded through the two programs. An ASQ-3 basic startup kit can be purchased for less than $1000.00 and handouts were purchased for approximately $500.00. Some of the most used educational pamphlets are available at no cost to health care organizations through the NYSDOH. The materials for set up include consents, EIP referral forms, the ASQ-3 screening tool kit, promotional giveaways and informational materials. Ongoing expenses involve copying ASQ’s, cost of mailing screenings to pediatricians, consents, educational brochures and handouts.
Objective 1:Improve knowledge and awareness of child growth and development for parents of children in the WIC program Performance measures used to evaluate the practice: 1. Number of WIC sessions/month that Child Find Nurse was present 2. Number of parents educated 3. Number of educational literature distributed: •“Early Help Makes a Difference”, developmental milestone checklist, NYSDOH •“Learn The Signs”, autism awareness, NYSDOH •“Lead Poisoning is a Danger for every baby and child, NYSDOH •“Helping Parents Make a Difference”, program brochure, Nassau County Office of Children with Special Needs •Developmental activity cards, play based parent and child activities to foster developmental in 3 -6 month age intervals, Denver Developmental Activities and Noodle Soup catalog •Home safety checklist •Long Island Early Childhood Direction Center, program brochure Data: Primary data is collected by the nurse conducting the screenings at WIC. The Child Find Nurse records a tally of the number of families that receive education at each screening date. This count reflects the number of families that speak with the nurse and/or obtain informational materials. A brief report including the tally, total number of children screened, and specific cases referred to CF or EI is submitted to the CF supervisor after each screening date. The Supervisor maintains an excel spreadsheet with counts and a log of specific children referred. There are 2 screening dates per month. The tally averages 31 (30.6) parents that receive education per session. An average of 12 of these children is screened per day and an average of 19 families receiving education only. Over 31 sessions from April 1, 2011 through September 30, 2012, it is estimated that approximately 961 parents received education.The LHD has observed the following: These WIC numbers reflect a substantial increase in parents reached as compared to other community outreach activities at which only 3 to 10 families participate. Counting the number of WIC families receiving education was added in 2012. Therefore, the total number of families educated since inception of the program, is reported as an average estimate, based on data collected over the past 4 months and extrapolated over the duration of the program. The numbers for children screened, and their outcomes, are actual numbers as this count has been recorded for each session since program inception. Feedback: Data collected from this program is reported to the Health Commissioner and the Board of Health on a monthly basis. An overview of the program and findings were presented to the Local Early Intervention Coordinating Council at the biannual meeting in September,2012. Parents are interested in the handouts. While a specific tally of the specific educational literature distributed is not kept, observation indicates that the “Early Help Makes a Difference” and the developmental activity cards are the most popular informational materials. Adding giveaways (outlet protector with EIP logo) to the educational table is informally observed to increase the number of parents approaching the educational table on their own volition. Enhancing the data collection to include the tally count of families educated, provides information used to gauge the effectiveness of the outreach and aids in ordering materials. A recent breakdown of the tally count to English and Spanish speaking as primary language documented the need for a more consistent bilingual Spanish staff. Objective 2:Improve access to early intervention services for children in the WIC program by providing initial developmental screening at the WIC site. The Performance measures used to evaluate the practice: The number of children screened at WIC sessions and the three categories of screening results: 1. Number screened and found to be within normal limits, 2. Number screened and found to be at risk 3. Number screened and found to be demonstrating a delay The Child Find Nurse's report of activities during the WIC session is the data source used for the evaluation. During the 18 months of this program, 31 sessions were conducted and 961 families were educated. 334 children (34%) were screened: Of children screened: 255 children did not exhibit a delay (76%); 51 children were identified as at risk and recommended for referral to Child Find; 28 children were screened and recommended for referral to Early Intervention for a complete evaluation due to a suspected developmental delay. Objective 3 will detail the outcomes of these cases. The Child Find Nurse's report of activities during the WIC session is the primary data source used for the evaluation. During the 18 months of this program, 31 sessions were conducted and 961 families were educated. 334 children (34%) were screened: Of children screened: 255 children did not exhibit a delay (76%); 51 children were identified as at risk and recommended for referral to Child Find; 28 children were screened and recommended for referral to Early Intervention for a complete evaluation due to a suspected developmental delay. Objective 3 will detail the outcomes of these cases.The LHD has observed the following: Approximately 34% of parents who receive developmental education request a screening for their child to learn about their developmental status. This indicates strong parental interest in learning about their child’s development. Screening at WIC yields almost 18% (referrals into EI and Child Find from WIC) of children with developmental concerns. The percentage of referrals to EI and Child Find related to the total population in Nassau County is 10% (2009 United States Census Bureau). There is a significant increase in the number of children requiring referrals to EI and Child Find within the WIC population. Providing initial developmental screening at the WIC site improves access to Early Intervention and Child Find. Data collected from this program is reported to the Health Commissioner and the Board of Health on a monthly basis. An overview of the program and findings were presented to the Local Early Intervention Coordinating Council at the biannual meeting in September, 2012. Due to the public response and findings, Screen for Success has recently added a third screening date per month at the Freeport/Roosevelt WIC site. Objective 3:Reduce barriers to utilization of early intervention services for eligible children in the WIC program by providing enhanced case coordination (system navigation and health literacy). Performance measures used to evaluate the practice: Outcome of children screened in WIC that were identified as demonstrating a developmental concern who were: 1. Recommended for referral to Early Intervention, 2. Actually referred (and case opened), 3. Disposition of the cases opened Data: The Child Find Nurse is the primary data source used for evaluation. Of the 51 children recommended for Child Find, 9 parents declined and 42 children have been successfully enrolled in Child Find to participate in ongoing developmental tracking. Of the 28 cases suspected of developmental delay, 19 children were directly referred to EIP by the Child Find Nurse, 9 parents declined referral to Early Intervention. Current status of the 19 children referred: 6 are receiving services, 3 were not eligible, 3 were lost to follow up and 7 are pending evaluation results.Evaluation results: 82% of children identified with at risk factors were successfully enrolled in Child Find and are currently participating or have participated in ongoing developmental surveillance for some period of time. This surveillance includes follow up with the Child Find Nurse by any combination of contact by telephone, mail in ASQ-3, and/or home visit screening based on need. The movement out of CF is fluid as children can leave due to age-out, referral to EI, 2 subsequent screenings with normal results or parent request. The outcomes of children being referred to EI due to suspected delay are being tracked. 68% of children with a suspected delay have been successfully opened to Early Intervention for further evaluation. Not all children actually receive evaluations. Parents may withdraw from program prior to evaluation or be lost to follow up due to lack of response to attempts to contact. The challenge remains in keeping families engaged throughout the process of enrollment to the actual provision of services. The LHD has observed the following: Both our WIC families and LHD professional staff in Early Intervention and WIC have identified this practice as highly valuable. WIC families are interested in learning about the growth and development of their children and one third of parents educated agree for their child to have a developmental screening by the Child Find Nurse while at the WIC site. Children screened at WIC appear to have a significantly higher incidence of developmental Feedback: Data collected from this program is reported to the Health Commissioner and the Board of Health on a monthly basis. An overview of the program and findings were presented to the Local Early Intervention Coordinating Council at the biannual meeting in September, 2012. The Child Find team regularly reviews the project to identify problems and make necessary adjustments. Program review led to the addition of the tally to gauge educational participation, quantified the need for increased bilingual Spanish staff, and the development of procedures to aid in follow up for children who become disengaged from the early intervention process
Stakeholder CommitmentSustainability is thought to be relatively secure for the Screen for Success developmental screening collaborative. The project has recently expanded to add screening dates at the second largest WIC site largest site and is doing quite well. A Child Find Nurse provides educational outreach and screenings at the Hempstead site twice a month and on September 21, 2012 began the program at the Roosevelt WIC Office. There is significant stakeholder commitment in this project from the program level to the Commissioner and Board of Health. The EI and WIC programs recognize the importance of this partnership and both are committed to continued collaboration and enhancement of services. Essentially sustainability causes no fiscal hardship on either program. The WIC program provides unlimited access to a vulnerable population of children who would not ordinarily be screened for developmental delays. The LHD’s recognition of this work and encouragement in applying for a NACCHO model practice award is a source of pride for the staff involved. The Nassau County Department of Health remains committed and dedicated to ensuring that all children have equal access to our services. Screen for Success has proven to be an effective tool to reach this goal.SustainabilityThe associated costs for Screen for Success are absorbed into the existing programs’ budgets. The man-hours and resources are already used in the day to day operations of Child Find and WIC making sustainability from a fiscal standpoint realistic. Establishing staff at a WIC site has proven to be a highly effective means in providing the community awareness activities that are the responsibility of the Child Find component of the Early Intervention Program. There are future plans being worked out for 2013 to expand and improve the program. A third day per month for screenings at WIC will be added before the end of 2012. The LEICC Public Awareness Subcommittee has been enlisted to identify sources of developmental educational DVD’s to play in WIC’s waiting area in order to expand the educational outreach. Providing parents with appropriate educational support is an important factor in positive developmental outcomes for their child (Anotnelli, McAllister, and Popp, 2009). Outcome evaluation of this program identified the need for increased efforts to follow children who drop out prior to eligibility for early intervention is established. The same barriers that impede families from initially accessing early intervention services also affect them in completing the process through to enrollment. Steps are being designed and implemented to reengage these families. Adding bilingual Spanish Early Intervention/Child Find staff is an important step to enhancing coordination for families referred into Early Intervention. These measures and program enhancements will lead to the growth and sustainability of Screen for Success.
 
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