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DEVELOPMENTAL SURVEILLANCE AND SCREENING IN ORANGE COUNTY: STATE & LOCAL EFFORTS

DEVELOPMENTAL SURVEILLANCE AND SCREENING IN ORANGE COUNTY: STATE & LOCAL EFFORTS

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What is Surveillance? What is Surveillance?

A flexible, continuous process, in which knowledgeable A flexible, continuous process, in which knowledgeable professionals perform skilled observations of children during professionals perform skilled observations of children during child health carechild health care

(in consultation with families, specialists, child care (in consultation with families, specialists, child care providers, etc)providers, etc)..

  

SM Dworkin, A Shannon, and P Dworkin. ChildServ Curriculum. Center for Children’s Health and SM Dworkin, A Shannon, and P Dworkin. ChildServ Curriculum. Center for Children’s Health and Development, St Francis Hospital and Medical Center; 1999; Hartford, CT.Development, St Francis Hospital and Medical Center; 1999; Hartford, CT.

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What is What is ScreeningScreening?? What is What is ScreeningScreening??

A “brief assessment procedure designed to identify children who A “brief assessment procedure designed to identify children who should receive more intensive diagnosis or assessment.” (should receive more intensive diagnosis or assessment.” (AAP AAP 2001 Policy Statement2001 Policy Statement))

Brief, objective, and validated instrumentBrief, objective, and validated instrument

Identify children that are “probably OK” vs. children needing Identify children that are “probably OK” vs. children needing “more comprehensive evaluation”“more comprehensive evaluation”

Performed at a set point in timePerformed at a set point in time

Objective vs. subjective impressionsObjective vs. subjective impressions

Results always interpreted in contextResults always interpreted in context

Never in isolationNever in isolation

Aid to ongoing surveillanceAid to ongoing surveillance

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Developmental Screening: When to Test (AAP Recommendations)

Developmental Screening: When to Test (AAP Recommendations)

Infants and young children should be screened for Infants and young children should be screened for developmental delays using reliable and valid screening developmental delays using reliable and valid screening techniques at 9,18,(24), 30 monthstechniques at 9,18,(24), 30 months

Use of standardized developmental screening tools at periodic Use of standardized developmental screening tools at periodic intervals will increase accuracyintervals will increase accuracy

Use parent-report questionnaires or directly administered tools Use parent-report questionnaires or directly administered tools with sensitivity and specificity of at least 70-80% with sensitivity and specificity of at least 70-80%

Additional information about AAP guidelines and Additional information about AAP guidelines and recommendations is contained in the 2006 Policy Statement on recommendations is contained in the 2006 Policy Statement on developmental surveillance and screening developmental surveillance and screening ((http://www.medicalhomeinfo.org/screening/index.html)http://www.medicalhomeinfo.org/screening/index.html)

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Benefits of ScreeningBenefits of Screening

Identifies children at-risk for possible developmental delaysIdentifies children at-risk for possible developmental delays

Detects child’s strengths and needsDetects child’s strengths and needs

May provide an opportunity to address family concerns, May provide an opportunity to address family concerns, educate parents on child development, empower parents educate parents on child development, empower parents (involvement)(involvement)

Assists in triaging children into 3 possible service approaches:Assists in triaging children into 3 possible service approaches:

Needs additional evaluationNeeds additional evaluation

Needs close monitoringNeeds close monitoring

Needs ongoing monitoring in theNeeds ongoing monitoring in the context of well-child context of well-child carecare

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Benefits of Early DetectionBenefits of Early Detection

Leads to early treatment & improved health outcomesLeads to early treatment & improved health outcomes

Positive benefit on later school performancePositive benefit on later school performance

Opportunity to avert secondary problemsOpportunity to avert secondary problems

Save society $30,000 - $100,000 per childSave society $30,000 - $100,000 per child

Potential to enhance social and family relationshipsPotential to enhance social and family relationships

Addresses Healthy People 2010, Bright Futures, IDEA, AAP Addresses Healthy People 2010, Bright Futures, IDEA, AAP Periodicity Schedule, EPSDT, etc.Periodicity Schedule, EPSDT, etc.

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Incidence of Children with DisabilitiesIncidence of Children with Disabilities

2.6% of children 0-2 years are identified as having a 2.6% of children 0-2 years are identified as having a disabilitydisability

5.2% of children age 3-5 are identified as having a disability5.2% of children age 3-5 are identified as having a disability

12.7% of school age children are identified as having a 12.7% of school age children are identified as having a disabilitydisability

Studies estimate 25% to 50% of maltreated children Studies estimate 25% to 50% of maltreated children experience developmental delaysexperience developmental delays

It is estimated that 30% to 40% of foster youth are in the It is estimated that 30% to 40% of foster youth are in the special education system (a significantly higher percentage special education system (a significantly higher percentage than non-foster care youth)than non-foster care youth)

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Screenings

Early Start

Community Services

Early Careand

Education

Special Education

Navigatingthe System

Gaps in Resources

Eligibility LimitsBarriers to Services

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Infant Toddler Preschool Kindergarten

Connecting Families & Children toImprove Developmental Outcomes

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CA Developmental Service OpportunitiesCA Developmental Service Opportunities

State of CaliforniaState of California ABCD InitiativeABCD Initiative

State of CaliforniaState of California Mental Health Services ActMental Health Services Act

First 5 Association of CaliforniaFirst 5 Association of California Early Childhood Mental Health Early Childhood Mental Health Systems Change Planning GrantSystems Change Planning Grant

First 5 CaliforniaFirst 5 California Children with Special Needs Children with Special Needs Demonstration ProjectsDemonstration Projects

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Assuring Better Child Health and Development (ABCD) Screening Academy

Assuring Better Child Health and Development (ABCD) Screening Academy

15 month national consortium to improve policy and 15 month national consortium to improve policy and clinical practice so that children’s developmental and clinical practice so that children’s developmental and behavioral conditions are identified and treated at an behavioral conditions are identified and treated at an early age. early age.

Administered by the National Academy of State Health Administered by the National Academy of State Health Policy, funded by The Commonwealth FundPolicy, funded by The Commonwealth Fund

18 states participate, including California18 states participate, including California

CA Department of Public Health / MCAH Branch is leadCA Department of Public Health / MCAH Branch is lead

More information about the ABCD Initiative is available More information about the ABCD Initiative is available at www.nashp.orgat www.nashp.org

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ABCD Logic Model: System / Policy Level StrategiesABCD Logic Model: System / Policy Level Strategies

Incentives and MotivationIncentives and Motivation

Shared Vision and EngagementShared Vision and Engagement

Community Supports for Recognition and ResponseCommunity Supports for Recognition and Response

Promote Leadership and CollaborationPromote Leadership and Collaboration

Capability and Capacity for CareCapability and Capacity for Care

Promoting Continuous Learning CulturePromoting Continuous Learning Culture

Performance MeasurementPerformance Measurement

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Mental Health Services Act (MHSA): Prevention and Early Intervention (PEI)Mental Health Services Act (MHSA):

Prevention and Early Intervention (PEI)

MHSA, passed in November 2004 (Prop 63) will expand mental health MHSA, passed in November 2004 (Prop 63) will expand mental health care for childrencare for children

Funds will be directed to new or expanded programs based on models Funds will be directed to new or expanded programs based on models proven to be effective proven to be effective

PEI documented strategies include: Mental Health Consultation in PEI documented strategies include: Mental Health Consultation in Primary Care, Nurse-Family Partnership, First Steps, Healthy Steps, Primary Care, Nurse-Family Partnership, First Steps, Healthy Steps, Integrated Primary Care and Mental Health Services, ASQ and ASQ-Integrated Primary Care and Mental Health Services, ASQ and ASQ-SE, Brief Infant-Toddler Social Emotional Assessment, Parental SE, Brief Infant-Toddler Social Emotional Assessment, Parental Depression Screening, Early Start, Infant Parent Program, Partners in Depression Screening, Early Start, Infant Parent Program, Partners in Prevention, CHDP & other Screening, Universal Access to Voluntary Prevention, CHDP & other Screening, Universal Access to Voluntary Screening, Healthy Start, Professional Development, FRC’s, Early Screening, Healthy Start, Professional Development, FRC’s, Early Childhood Mental Health ResourcesChildhood Mental Health Resources

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First 5 Association – Early Childhood Mental Health (ECMH) Systems Change

First 5 Association – Early Childhood Mental Health (ECMH) Systems Change

California Endowment funded project to explore systemic California Endowment funded project to explore systemic barriers to the delivery and funding of mental health services barriers to the delivery and funding of mental health services for children 0 – 5 and their families. for children 0 – 5 and their families.

Project participants include First 5 representatives and other Project participants include First 5 representatives and other key partners (mental health, child care, Regional Center, key partners (mental health, child care, Regional Center, R&R, SELPAs, community agencies)R&R, SELPAs, community agencies)

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ECMH – Key StrategiesECMH – Key Strategies

Universal screening for mental health at appropriate Universal screening for mental health at appropriate periodicity at well child and prenatal visits.periodicity at well child and prenatal visits.

Reimbursement for early childhood mental health screening, Reimbursement for early childhood mental health screening, assessment and treatment.assessment and treatment.

Statewide social marketing campaign to promote the Statewide social marketing campaign to promote the importance of early childhood social-emotional well-being.importance of early childhood social-emotional well-being.

Statewide system for training, recruiting and retaining multi-Statewide system for training, recruiting and retaining multi-disciplinary early childhood mental health professionals with disciplinary early childhood mental health professionals with uniform competenciesuniform competencies..

Strategies identified for development of an action plan includes:Strategies identified for development of an action plan includes:

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$$10 Million invested over 4 years to support Special 10 Million invested over 4 years to support Special Needs Demonstration Projects in California. There is a Needs Demonstration Projects in California. There is a local match of equal value. Emphasis areas include:local match of equal value. Emphasis areas include:

Universal access to screening for early identificationUniversal access to screening for early identification

Improved access to and utilization of servicesImproved access to and utilization of services

Inclusion of children with special needs in appropriate, Inclusion of children with special needs in appropriate, typical preschools and other settingstypical preschools and other settings

Workforce DevelopmentWorkforce Development

Evaluation of effective practices to improve programsEvaluation of effective practices to improve programs

http://www.first5caspecialneeds.orghttp://www.first5caspecialneeds.org

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First 5 Definition: Children with Special NeedsFirst 5 Definition: Children with Special Needs

Children with identified disability, health, or mental health Children with identified disability, health, or mental health conditions requiring early intervention, special education conditions requiring early intervention, special education services, or other specialized services and supportsservices, or other specialized services and supports

oror

Children without identified conditions, but requiring Children without identified conditions, but requiring specialized services, supports, or monitoringspecialized services, supports, or monitoring

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Children and Families Commission of Orange CountyDevelopmental Strategies

Children and Families Commission of Orange CountyDevelopmental Strategies

Vision: All children are healthy and ready to learnVision: All children are healthy and ready to learn

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4-6%

20%

40%

100%

Assessment and Therapy Provision

Mid-Level Developmental Assessment and Interventions

Secondary Screening and Surveillance

Community-Based Developmental Surveillance & Screening

Model based on UCLA Center for Healthier Children, Families and Communities in July 2004 Pathways Report

Pyramid of Needs for Developmental / Behavioral Services

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OpportunitiesOpportunities: : Increasing resources to address developmental needsIncreasing resources to address developmental needs Dedicated providers and policy leadersDedicated providers and policy leaders Availability of evidence-based screening toolsAvailability of evidence-based screening tools Targeted investments by Commission and other funders Targeted investments by Commission and other funders Increasing parent and community awarenessIncreasing parent and community awareness

ChallengesChallenges:: Gaps in servicesGaps in services Restricted eligibility Restricted eligibility Lack of service integration and coordinationLack of service integration and coordination Accessibility to services, impacting early identificationAccessibility to services, impacting early identification

Developmental / Behavioral Pathways System: Opportunities & Challenges

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American Academy of Pediatrics, CA American Academy of Pediatrics, CA Chapter 4Chapter 4

CalOptimaCalOptima

CFCOCCFCOC

Children’s Hospital of Orange County Children’s Hospital of Orange County (CHOC)(CHOC)

CHOC/UCI Neurodevelopmental CHOC/UCI Neurodevelopmental Programs (including Help Me Grow)Programs (including Help Me Grow)

Coalition of Orange County Community Coalition of Orange County Community ClinicsClinics

County of Orange Health Care AgencyCounty of Orange Health Care Agency

California Children’s ServicesCalifornia Children’s Services

Behavioral Health ServicesBehavioral Health Services

County of Orange Social Services County of Orange Social Services AgencyAgency

Family Support NetworkFamily Support Network

HealthCare Foundation for Orange HealthCare Foundation for Orange CountyCounty

Kaiser PermanenteKaiser Permanente

Newport Mesa Unified School DistrictNewport Mesa Unified School District

Orange County Department of EducationOrange County Department of Education

Regional Center of OCRegional Center of OC

University of California, Irvine Medical University of California, Irvine Medical CenterCenter

Pathways Leadership Committee Representation

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All children, birth through age five, in Orange County will have recommended developmental/behavioral baseline screenings at

milestone ages with linkage to appropriate services.

Build Infrastructure

Develop Relationships

Among Providers

Strengthen Service

Coordination

Raise Awareness

Four Primary Goals to Achieve Outcome

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Goal 1: Develop the Infrastructure

Build system capacity to maximize identification of all children with Build system capacity to maximize identification of all children with developmental/behavioral needs and ensure availability of resourcesdevelopmental/behavioral needs and ensure availability of resources

Implement universal release of information formImplement universal release of information form

Promote use of validated assessment and screening tools Promote use of validated assessment and screening tools

Monitor and evaluate Pathways systemMonitor and evaluate Pathways system

Goal 2: Develop Relationships Among Community Partners Promote networking among community partners to ensure effective Promote networking among community partners to ensure effective

collaboration and service coordinationcollaboration and service coordination Develop and sustain linkages among community partners to ensure Develop and sustain linkages among community partners to ensure

children and families are referred to needed serviceschildren and families are referred to needed services Develop and sustain collaborative projectsDevelop and sustain collaborative projects Utilize incentives (e.g. policies, innovative financing, etc.) to facilitate Utilize incentives (e.g. policies, innovative financing, etc.) to facilitate

and sustain relationship-promoting strategiesand sustain relationship-promoting strategies

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Goal 3: Strengthen Service Coordination Build strategic alliances to improve delivery of coordinated Build strategic alliances to improve delivery of coordinated

developmental and behavioral servicesdevelopmental and behavioral services

Implement developmental/behavioral screenings of children, birth Implement developmental/behavioral screenings of children, birth through age five, with community partnersthrough age five, with community partners

Ensure and sustain a trained and culturally competent workforce Ensure and sustain a trained and culturally competent workforce

Increase surveillance of children, ages birth through 5, by early Increase surveillance of children, ages birth through 5, by early education and community-based service providers (e.g., WIC, social education and community-based service providers (e.g., WIC, social service agencies)service agencies)

Goal 4: Raise Public & Professional Awareness

Launch a public awareness campaign aimed at Orange County Launch a public awareness campaign aimed at Orange County families, providers and the general publicfamilies, providers and the general public

Encourage all parent education programs to support families in Encourage all parent education programs to support families in promoting healthy childhood developmentpromoting healthy childhood development

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The recommended goals, strategies and action steps in the proposed plan The recommended goals, strategies and action steps in the proposed plan are designed to:are designed to:

Increase the number of children, birth through age five, that receive Increase the number of children, birth through age five, that receive regular developmental screens as part of their primary care visits at regular developmental screens as part of their primary care visits at intervals defined by AAPintervals defined by AAP

Ensure all services are family centeredEnsure all services are family centered

Establish Help Me Grow as the “Gateway” to Pathways system and Establish Help Me Grow as the “Gateway” to Pathways system and servicesservices

Provide on-going management and measurement of the overall Provide on-going management and measurement of the overall system of care to stimulate improvement and innovationsystem of care to stimulate improvement and innovation

Goals, Strategies & Action Steps

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First 5 Special Needs Demonstration Project: The LEAPS Program Learning, Early-intervention, And Parent Support” First 5 Special Needs Demonstration Project: The LEAPS Program Learning, Early-intervention, And Parent Support”

Grantee: Newport-Mesa Unified School District Grantee: Newport-Mesa Unified School District

The LEAPS Program Builds on a School Readiness Program The LEAPS Program Builds on a School Readiness Program Foundation to provide universal access for screening for early Foundation to provide universal access for screening for early identification and referrals for physical and developmental concerns, identification and referrals for physical and developmental concerns, including socio-emotional concerns. including socio-emotional concerns.

Key Partners: University of California, Irvine, Orange County Key Partners: University of California, Irvine, Orange County Mental Health, Providence Mental Health, Matt Kline Head Start, Mental Health, Providence Mental Health, Matt Kline Head Start, Regional Center of Orange County, Families Costa Mesa, Harper Regional Center of Orange County, Families Costa Mesa, Harper Assessment Center, BRIDGES for Newborns Program, Children’s Assessment Center, BRIDGES for Newborns Program, Children’s Hospital of Orange County, Hoag HospitalHospital of Orange County, Hoag Hospital

Strategies: Preschool Program, Kindergarten Transition, Healthy Strategies: Preschool Program, Kindergarten Transition, Healthy Start, Parent Empowerment, Adult Education - Family Literacy Start, Parent Empowerment, Adult Education - Family Literacy /English and GED, Professional Development, School Readiness /English and GED, Professional Development, School Readiness Resource Center, Public Awareness -Resource Center, Public Awareness -

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Early Childhood System of Care (ECSOC)Early Childhood System of Care (ECSOC)

Collaborative of the OC Health Care Agency and Social Collaborative of the OC Health Care Agency and Social Services AgencyServices Agency

4 Public Health Nurses provide intensive case management 4 Public Health Nurses provide intensive case management services for a 3 month period to children 0-5 entering the services for a 3 month period to children 0-5 entering the dependency systemdependency system Ensure children are connected to a medical homeEnsure children are connected to a medical home

Develop care plans & coordinate medical, developmental & Develop care plans & coordinate medical, developmental & behavioral health servicesbehavioral health services

Ensure children receive developmental screeningsEnsure children receive developmental screenings

Refer children for developmental assessments as neededRefer children for developmental assessments as needed

Link children and caretakers to community resourcesLink children and caretakers to community resources

Provide education and support to caregiversProvide education and support to caregivers

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Implemented in 2006 to address the high rate of Implemented in 2006 to address the high rate of developmental delays, disabilities & behavioral and emotional developmental delays, disabilities & behavioral and emotional problems experienced by children entering the child welfare problems experienced by children entering the child welfare systemsystem

Approx. 120 cases per PHN each monthApprox. 120 cases per PHN each month

1545 children 0-5 served from July 1, 2007 to December 31, 1545 children 0-5 served from July 1, 2007 to December 31, 2007:2007:

593 individual care plans developed593 individual care plans developed

476 referrals made to community health providers476 referrals made to community health providers

265 developmental screenings265 developmental screenings

288 referrals made for psychosocial & developmental services288 referrals made for psychosocial & developmental services

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ECSOC Community PartnersECSOC Community Partners Western Youth ServicesWestern Youth Services

CHOC/UCI Neurodevelopmental ProgramsCHOC/UCI Neurodevelopmental Programs

For OC KidsFor OC Kids

Early Developmental Assessment Center (EDAC)Early Developmental Assessment Center (EDAC)

Help Me GrowHelp Me Grow

School DistrictsSchool Districts

School Readiness Nurses and CoordinatorsSchool Readiness Nurses and Coordinators

Regional Center Regional Center

Family Support NetworkFamily Support Network

Family Resource Centers (FRCs)Family Resource Centers (FRCs)

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The Kinship CenterThe Kinship Center The Seedling Project: Early Intervention ProgramThe Seedling Project: Early Intervention Program

Developmental and behavioral screenings are provided to Developmental and behavioral screenings are provided to Orange County dependent children;Orange County dependent children;

Child/family specific plans are developed and early Child/family specific plans are developed and early intervention support services are provided to support intervention support services are provided to support placements, improve attachment & increase school readinessplacements, improve attachment & increase school readiness

The Adoption ClinicThe Adoption Clinic

Mental health and counseling services provided to children Mental health and counseling services provided to children who are adopted or in foster care with a permanent plan of who are adopted or in foster care with a permanent plan of adoption or legal guardianship;adoption or legal guardianship;

Services provided by child and family therapists include Services provided by child and family therapists include individual, group & family counseling, psychological individual, group & family counseling, psychological evaluations, psychiatric services, occupational & speech evaluations, psychiatric services, occupational & speech therapy & moretherapy & more

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Help Me Grow-Orange CountyGateway to Improve Developmental Outcomes for Children Birth - 5

Toll free number 1.866.GROW.025 activated in 2007 in partnership with 2-1-1

Connect children & families to developmental resources and services

Create a network of community resources with relationship building of community providers & maintenance of an updated resource inventory

Identify gaps & barriers to services

Educate providers about importance of developmental surveillance & screening

Train providers on use of evidence based screening tools including ASQ & ASQ-SE

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ABCD Pilots – Orange County ProjectsABCD Pilots – Orange County Projects American Academy of Pediatrics, Chapter 4American Academy of Pediatrics, Chapter 4

1 community clinic, 3 MD offices, 3 early care & education centers 1 community clinic, 3 MD offices, 3 early care & education centers located in South County. Formal developmental screenings to be located in South County. Formal developmental screenings to be completed at well child visits.completed at well child visits.

County ClinicCounty Clinic

2 clinics, 1 in Santa Ana and in Buena Park, will incorporate the ASQ 2 clinics, 1 in Santa Ana and in Buena Park, will incorporate the ASQ into well child care visits.into well child care visits.

Medi-Cal Managed Care (CalOptima)Medi-Cal Managed Care (CalOptima)

Healthy Families providers in Santa Ana and AnaheimHealthy Families providers in Santa Ana and Anaheim

Help Me GrowHelp Me Grow

ASQ developmental monitoring program implemented; initially 4 to 5 ASQ developmental monitoring program implemented; initially 4 to 5 primary health care sites will enroll families at well child visits.primary health care sites will enroll families at well child visits.

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ABCD Pilots – Orange County Outcomes ABCD Pilots – Orange County Outcomes

Increase the number of appropriate, high quality developmental Increase the number of appropriate, high quality developmental screens performed in practice settingsscreens performed in practice settings

Increase the number of age-appropriate referrals to sites that Increase the number of age-appropriate referrals to sites that provide developmental servicesprovide developmental services

Increase the number of children ages 0 – 3 who receive Increase the number of children ages 0 – 3 who receive developmental services and family supportsdevelopmental services and family supports

Developmental screenings are routine at well-child visits in the Developmental screenings are routine at well-child visits in the pediatrician’s officepediatrician’s office

Parents understand developmental milestones / behaviors and Parents understand developmental milestones / behaviors and ways to facilitate healthy developmentways to facilitate healthy development

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FAMILYFAMILY

PRIMARY HEALTHCARE

PROVIDER

HELP ME

GROWCOMMUNITY

SERVICE PROVIDERS

EDUCATIONAL COMMUNITY

Primary Healthcare Providers:-Developmental Surveillance with formal screenings at 9,18 and 24 to 30 months-Anticipatory guidance-Care Coordination

Regional Center

Private Providers/ Specialized Therapists

Early Literacy Support

CCS-High Risk Infant (EDAC)

LEAPS

HCA - Western Youth Services

Early Care & Education:-Input on developmental progress -Anticipatory guidance

Help Me Grow:- Gateway for the Orange County Pathways system-Community and professional awareness-Connects families with community resources -Support to primary healthcare sites

For OC Kids NDC

Emerging Integrated Developmental &Behavioral Pathways System

CUIDAR\COPE

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OC Developmental & Behavioral Pathways